=====================================================
General NPI Number Information
=====================================================
NPI Number | 1184693897
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | KELLY JAMES COCHRANE OD
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/15/2006
-----------------------------------------------------
Last Update Date | 12/04/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 9825 SANDIFUR PKWY SUITE B
-----------------------------------------------------
City | PASCO
-----------------------------------------------------
State | WA
-----------------------------------------------------
Zip | 99301-6738
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 509-547-6998
-----------------------------------------------------
Fax | 509-547-6966
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 4013
-----------------------------------------------------
City | PASCO
-----------------------------------------------------
State | WA
-----------------------------------------------------
Zip | 99302-4013
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 509-547-6998
-----------------------------------------------------
Fax | 509-547-6966
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 152W00000X
-----------------------------------------------------
Taxonomy Name | Optometrist
-----------------------------------------------------
License Number | 1536TX
-----------------------------------------------------
License Number State | WA
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 152W00000X
-----------------------------------------------------
Taxonomy Name | Optometrist
-----------------------------------------------------
License Number | 1629D
-----------------------------------------------------
License Number State | OR
-----------------------------------------------------