MEDICARE: YVONNE COCHRAN

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	156FX1201X	Optometric Assistant Technician

General Provider Information

NPI Number	:	1669465167
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	YVONNE COCHRAN

Provider Business Mailing Address
First Line	:	2301 S WATER ST
Second Line	:
City	:	WICHITA
State	:	KS
Zip	:	67213-4819
Country	:	US
Telephone Number	:	316-682-4646
Fax Number	:	316-263-4116

Provider Business Practice Location Address
First Line	:	2301 S WATER ST
Second Line	:
City	:	WICHITA
State	:	KS
Zip	:	67213-4819
Country	:	US
Telephone Number	:	316-682-4646
Fax Number	:	316-263-4116

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

Provider Enumeration Date	:	08/30/2005
Last Update Date	:	07/08/2007

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Directions to “ YVONNE COCHRAN ” Practice Location

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