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General NPI Number Information
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NPI Number | 1912043605
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Entity Type | Organization
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Legal Business Name | COCKERHAM EYE CONSULTANTS PROFESSIONAL CORPORATION
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Dates
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Enumeration Date | 01/29/2007
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Last Update Date | 12/24/2025
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Provider Practice Location Address
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Address Line | 3636 CAMINO DEL RIO N STE 200
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City | SAN DIEGO
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State | CA
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Zip | 92108-1702
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Country | US
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Telephone | 619-655-3075
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 503148
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City | SAN DIEGO
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State | CA
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Zip | 92150-3148
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Country | US
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Telephone | 858-759-4765
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DR. KIMBERLY P COCKERHAM
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Credential | MD
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Telephone | 650-804-9270
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207W00000X
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Taxonomy Name | Ophthalmology Physician
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License Number | G86885
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License Number State | CA
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