Healthcare Provider Details

I. General information

NPI: 1679564736
Provider Name (Legal Business Name): HOWARD ROBERT COHEN OD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/28/2005
Last Update Date: 09/10/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

190 CORAM AVE
SHELTON CT
06484-3347
US

IV. Provider business mailing address

190 CORAM AVE
SHELTON CT
06484-3347
US

V. Phone/Fax

Practice location:
  • Phone: 203-924-2175
  • Fax: 203-924-9232
Mailing address:
  • Phone: 203-924-2175
  • Fax: 203-924-9232

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number000738
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: