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General NPI Number Information
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NPI Number | 1558459800
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Entity Type | Organization
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Legal Business Name | COBB CORNER EYE CARE
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Dates
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Enumeration Date | 10/11/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 89 SHARON ST
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City | STOUGHTON
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State | MA
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Zip | 02072-2011
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Country | US
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Telephone | 781-344-3331
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Fax | 781-344-4717
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Provider Business Mailing Address
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Address Line | 89 SHARON ST
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City | STOUGHTON
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State | MA
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Zip | 02072-2011
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Country | US
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Telephone | 781-344-3331
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Fax | 781-344-4717
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Authorized Official
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Title or Position | OWNER
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Name | DANIEL W THURM
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Credential | OD
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Telephone | 781-344-3331
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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 | 3021
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License Number State | MA
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