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NPI Code Detail

MEDICARE: DR. ELIOT NEIL COHEN O.D.

MEDICARE: DR. ELIOT NEIL 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
1152W00000XOptometrist2653MA

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1W16135OTHERMAHMO BLUE
25658344OTHERAETNA US HEALTHCARE

General Provider Information

NPI Number : 1366430779
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. ELIOT NEIL COHEN O.D.
Provider Business Mailing Address
First Line : 636 COLUMBIA RD
Second Line :
City : DORCHESTER
State : MA
Zip : 02125-3416
Country : US
Telephone Number : 617-825-9839
Fax Number : 617-825-6654
Provider Business Practice Location Address
First Line : 636 COLUMBIA RD
Second Line :
City : DORCHESTER
State : MA
Zip : 02125-3416
Country : US
Telephone Number : 617-825-9839
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/10/2005
Last Update Date : 01/19/2017

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