MEDICARE: DR. MICHAEL GARY COHEN O.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	152WC0802X	Corneal and Contact Management Optometrist	0618000156	VA
2	152WL0500X	Low Vision Rehabilitation Optometrist	0618000156	VA

General Provider Information

NPI Number	:	1093711640
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MICHAEL GARY COHEN O.D.

Provider Business Mailing Address
First Line	:	9814 SUMMERDAY DR
Second Line	:
City	:	BURKE
State	:	VA
Zip	:	22015-4027
Country	:	US
Telephone Number	:	703-425-6851
Fax Number	:	703-425-3560

Provider Business Practice Location Address
First Line	:	4680 KING ST
Second Line	:
City	:	ALEXANDRIA
State	:	VA
Zip	:	22302-1215
Country	:	US
Telephone Number	:	703-845-1404
Fax Number	:	703-845-5945

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/27/2005
Last Update Date	:	09/11/2025

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