MEDICARE: DR. JAMES ELLIS COSBY 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	152W00000X	Optometrist	1852	GA

General Provider Information

NPI Number	:	1316937063
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JAMES ELLIS COSBY O.D

Provider Business Mailing Address
First Line	:	2616 POINTE NORTH BLVD
Second Line	:
City	:	ALBANY
State	:	GA
Zip	:	31721-1526
Country	:	US
Telephone Number	:	229-435-7795
Fax Number	:	229-883-0774

Provider Business Practice Location Address
First Line	:	2616 POINTE NORTH BLVD
Second Line	:
City	:	ALBANY
State	:	GA
Zip	:	31721-1526
Country	:	US
Telephone Number	:	229-435-7795
Fax Number	:	229-883-0774

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

Provider Enumeration Date	:	10/25/2005
Last Update Date	:	04/10/2018

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