MEDICARE: DR. KELLY JAMES COCHRANE OD

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	152W00000X	Optometrist	1536TX	WA
2	152W00000X	Optometrist	1629D	OR

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
10	410016584	OTHER		TRAVELERS MEDICARE RETIRE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	410016585	OTHER		UPPR
2	022886003	OTHER		REGENCE OREGON
3	032340000	OTHER		CIGNA
4	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
5	CO6992	OTHER		REGENCE WASHINGTON
6	554048	OTHER		AETNA
7	610605300	OTHER		DEPT OF LABOR SEATTLE DFE
8	8886644808	OTHER		COMM HEALTH PLAN OF WA
9	25764890	OTHER		GROUP HEALTH
11	0323400001	OTHER		MC SUPPY CIGNA DMERC REGD
12	0226424	OTHER	WA	DEPT LABOR AND INDUSTRIES

General Provider Information

NPI Number	:	1184693897
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. KELLY JAMES COCHRANE OD

Provider Business Mailing Address
First Line	:	PO BOX 4013
Second Line	:
City	:	PASCO
State	:	WA
Zip	:	99302-4013
Country	:	US
Telephone Number	:	509-547-6998
Fax Number	:	509-547-6966

Provider Business Practice Location Address
First Line	:	9825 SANDIFUR PKWY
Second Line	:	SUITE B
City	:	PASCO
State	:	WA
Zip	:	99301-6738
Country	:	US
Telephone Number	:	509-547-6998
Fax Number	:	509-547-6966

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

Provider Enumeration Date	:	03/15/2006
Last Update Date	:	12/04/2007

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