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General NPI Number Information
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NPI Number | 1801066360
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Entity Type | Organization
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Legal Business Name | HUBERT L. COCKRUM OD PA
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Dates
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Enumeration Date | 03/11/2008
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Last Update Date | 06/25/2008
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Provider Practice Location Address
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Address Line | 2183 HIGHWAY 62 W
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City | MOUNTAIN HOME
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State | AR
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Zip | 72653-6500
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Country | US
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Telephone | 870-425-1112
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Fax | 870-425-1278
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Provider Business Mailing Address
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Address Line | 2183 HIGHWAY 62 W
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City | MOUNTAIN HOME
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State | AR
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Zip | 72653-6500
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Country | US
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Telephone | 870-425-1112
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Fax | 870-425-1278
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Authorized Official
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Title or Position | DOCTOR
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Name | DR. HUBERT LAWERENCE COCKRUM
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Credential |
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Telephone | 870-425-1112
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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 | 2230
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License Number State | AR
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