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General NPI Number Information
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NPI Number | 1154598399
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Entity Type | Organization
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Legal Business Name | NORTHWOOD VISION CENTER
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Dates
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Enumeration Date | 05/15/2008
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Last Update Date | 05/15/2008
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Provider Practice Location Address
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Address Line | 2518 N MCMULLEN BOOTH RD STE C
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City | CLEARWATER
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State | FL
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Zip | 33761-4156
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Country | US
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Telephone | 727-725-5558
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Fax | 727-724-3966
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Provider Business Mailing Address
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Address Line | 2518 N MCMULLEN BOOTH RD STE C
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City | CLEARWATER
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State | FL
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Zip | 33761-4156
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Country | US
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Telephone | 727-725-5558
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Fax | 727-724-3966
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Authorized Official
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Title or Position | OWNER
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Name | DR. JOHN BARRY COCHRAN
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Credential | OD
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Telephone | 727-725-5558
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number | OPC1821
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License Number State | FL
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