MEDICARE: STEPHEN M. COHEN OD, P.C.

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	675	AZ

General Provider Information

NPI Number	:	1982956777
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	STEPHEN M. COHEN OD, P.C.

Provider Business Mailing Address
First Line	:	10900 N SCOTTSDALE RD STE 301
Second Line	:
City	:	SCOTTSDALE
State	:	AZ
Zip	:	85254-5230
Country	:	US
Telephone Number	:	480-513-3937
Fax Number	:	480-367-6711

Provider Business Practice Location Address
First Line	:	10900 N SCOTTSDALE RD STE 301
Second Line	:
City	:	SCOTTSDALE
State	:	AZ
Zip	:	85254-5230
Country	:	US
Telephone Number	:	480-513-3937
Fax Number	:	480-367-6711

Authorized Official
Title or Position	:	PRESIDENT
Name	:	STEPHEN MITCHELL COHEN
Credential	:	OD
Telephone Number	:	480-513-3937

Provider Enumeration Date	:	10/04/2012
Last Update Date	:	02/26/2013

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