MEDICARE: JOHN L COTTLE 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	2004016908	MO
2	152W00000X	Optometrist	1680	KS

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	:	1396743472
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JOHN L COTTLE O.D.

Provider Business Mailing Address
First Line	:	3700 SW CHEDDINGTON DR
Second Line	:
City	:	LEES SUMMIT
State	:	MO
Zip	:	64082-4797
Country	:	US
Telephone Number	:	816-623-9990
Fax Number	:	816-623-9990

Provider Business Practice Location Address
First Line	:	3700 SW CHEDDINGTON DR
Second Line	:
City	:	LEES SUMMIT
State	:	MO
Zip	:	64082-4797
Country	:	US
Telephone Number	:	816-623-9990
Fax Number	:	816-623-9449

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

Provider Enumeration Date	:	07/12/2005
Last Update Date	:	07/08/2019

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Directions to “ JOHN L COTTLE O.D.” Practice Location

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