Healthcare Provider Details

I. General information

NPI: 1669577086
Provider Name (Legal Business Name): D. BRADLEY COBB O.D., PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/13/2006
Last Update Date: 07/15/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4037 NOWATA RD
BARTLESVILLE OK
74006-5118
US

IV. Provider business mailing address

4037 NOWATA RD
BARTLESVILLE OK
74006-5118
US

V. Phone/Fax

Practice location:
  • Phone: 918-333-8989
  • Fax: 918-333-8991
Mailing address:
  • Phone: 918-333-8989
  • Fax: 918-333-8991

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number2095
License Number StateOK

VIII. Authorized Official

Name: DR. D BRADLEY COBB
Title or Position: PRESIDENT
Credential: OD
Phone: 918-333-8989