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General NPI Number Information
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NPI Number | 1275725152
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Entity Type | Organization
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Legal Business Name | COHRON FAMILY OPTOMETRIC SERVICES INC
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Dates
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Enumeration Date | 08/14/2007
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Last Update Date | 03/06/2012
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Provider Practice Location Address
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Address Line | 112 E MCMURTRY AVE
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City | HARTFORD
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State | KY
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Zip | 42347-1634
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Country | US
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Telephone | 270-298-7623
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Fax | 270-298-7624
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Provider Business Mailing Address
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Address Line | 112 E MCMURTRY AVE
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City | HARTFORD
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State | KY
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Zip | 42347-1634
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Country | US
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Telephone | 270-298-7623
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Fax | 270-298-7624
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Authorized Official
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Title or Position | OPTOMETRIST
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Name | DR. WALLCE TODD COHRON
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Credential | OD
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Telephone | 270-526-6800
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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 | 1372DT
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License Number State | KY
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