MEDICARE: COHRON FAMILY OPTOMETRIC SERVICES INC

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	1372DT	KY

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	410032987	OTHER	KY	RAILROAD MEDICARE IN HART
2	410032989	OTHER	KY	RAILROAD MEDICARE IN MORG

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
3	02144	OTHER	KY	SPECTERA IN HARTFORD
4	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
5	000000041898	OTHER	KY	BLUE CROSS/BLUE SHIELD
6	1524171	OTHER	KY	UMWA
7	000000041897	OTHER	KY	BLUE CROSS IN MORGANTOWN
8	02145	OTHER	KY	SPECTERA MORGANTOWN

General Provider Information

NPI Number	:	1275725152
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	COHRON FAMILY OPTOMETRIC SERVICES INC

Provider Business Mailing Address
First Line	:	112 E MCMURTRY AVE
Second Line	:
City	:	HARTFORD
State	:	KY
Zip	:	42347-1634
Country	:	US
Telephone Number	:	270-298-7623
Fax Number	:	270-298-7624

Provider Business Practice Location Address
First Line	:	112 E MCMURTRY AVE
Second Line	:
City	:	HARTFORD
State	:	KY
Zip	:	42347-1634
Country	:	US
Telephone Number	:	270-298-7623
Fax Number	:	270-298-7624

Authorized Official
Title or Position	:	OPTOMETRIST
Name	:	DR. WALLCE TODD COHRON
Credential	:	OD
Telephone Number	:	270-526-6800

Provider Enumeration Date	:	08/14/2007
Last Update Date	:	03/06/2012

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