=====================================================
General NPI Number Information
=====================================================
NPI Number | 1245735257
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | JEFFREY COHEN, O.D., INC.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/30/2018
-----------------------------------------------------
Last Update Date | 03/30/2018
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1555 SIMI TOWN CENTER WAY STE 575
-----------------------------------------------------
City | SIMI VALLEY
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 93065-0535
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 805-577-0255
-----------------------------------------------------
Fax | 805-526-4954
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2731 LICIA PL
-----------------------------------------------------
City | SIMI VALLEY
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 93065-1544
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 954-661-6553
-----------------------------------------------------
Fax | 805-526-4954
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | DR. JEFFREY M COHEN
-----------------------------------------------------
Credential | O.D.
-----------------------------------------------------
Telephone | 954-661-6553
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 152W00000X
-----------------------------------------------------
Taxonomy Name | Optometrist
-----------------------------------------------------
License Number | 14338
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------