MEDICARE: ERIC A COHN D.O.

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	207W00000X	Ophthalmology Physician	OS0006606	FL
2	174400000X	Specialist	OSOOO6606	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1124059340
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ERIC A COHN D.O.

Provider Business Mailing Address
First Line	:	2850 WELLNESS AVE
Second Line	:
City	:	ORANGE CITY
State	:	FL
Zip	:	32763-8395
Country	:	US
Telephone Number	:	386-574-0700
Fax Number	:	386-774-0121

Provider Business Practice Location Address
First Line	:	2850 WELLNESS AVE
Second Line	:
City	:	ORANGE CITY
State	:	FL
Zip	:	32763-8395
Country	:	US
Telephone Number	:	386-574-0700
Fax Number	:	386-774-0121

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

Provider Enumeration Date	:	07/05/2006
Last Update Date	:	10/02/2019

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