=====================================================
General NPI Number Information
=====================================================
NPI Number | 1902162589
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | DOUGLAS R. COX, O.D., INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/08/2012
-----------------------------------------------------
Last Update Date | 04/08/2012
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 3795 GREEN RD
-----------------------------------------------------
City | BEACHWOOD
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 44122-5705
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 216-292-6900
-----------------------------------------------------
Fax | 216-292-6944
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 3795 GREEN RD
-----------------------------------------------------
City | BEACHWOOD
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 44122-5705
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 216-292-6900
-----------------------------------------------------
Fax | 216-292-6944
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OPTOMETRIST
-----------------------------------------------------
Name | DR. DOUGLAS RAYMOND COX
-----------------------------------------------------
Credential | O.D.
-----------------------------------------------------
Telephone | 216-292-6900
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 152W00000X
-----------------------------------------------------
Taxonomy Name | Optometrist
-----------------------------------------------------
License Number | 3336/T391
-----------------------------------------------------
License Number State | OH
-----------------------------------------------------