MEDICARE: DR. MARK H COHN O.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	152W00000X	Optometrist	OD00001034	WA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1407856735
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MARK H COHN O.D.

Provider Business Mailing Address
First Line	:	15650 NE 24TH ST
Second Line	:	SUITE B
City	:	BELLEVUE
State	:	WA
Zip	:	98008-2460
Country	:	US
Telephone Number	:	425-746-9914
Fax Number	:	425-746-9916

Provider Business Practice Location Address
First Line	:	15650 NE 24TH ST
Second Line	:	SUITE B
City	:	BELLEVUE
State	:	WA
Zip	:	98008-2460
Country	:	US
Telephone Number	:	425-746-9914
Fax Number	:	425-746-9916

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/28/2005
Last Update Date	:	01/14/2010

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