Healthcare Provider Details

I. General information

NPI: 1568510816
Provider Name (Legal Business Name): DR JAMES W COBB, JR, PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/05/2007
Last Update Date: 01/04/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2186 HARRIS AVE NE SUITE 1
PALM BAY FL
32905-4044
US

IV. Provider business mailing address

2186 HARRIS AVE NE SUITE 1
PALM BAY FL
32905-4044
US

V. Phone/Fax

Practice location:
  • Phone: 321-724-2020
  • Fax: 321-724-9088
Mailing address:
  • Phone: 321-724-2020
  • Fax: 321-724-9088

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number
License Number State

VIII. Authorized Official

Name: DR. JAMES W COBB JR.
Title or Position: PRESIDENT
Credential: O.D.
Phone: 321-724-2020