MEDICARE: JAMES WILLIAM COBB JR. 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	OPC 974	FL

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
6	580098649	OTHER	FL	RAILROAD MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	048031001	OTHER	FL	DMERC
2	7147100	OTHER	FL	CIGNA
3	4497605	OTHER	FL	AETNA PPO
4	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
5	19549	OTHER	FL	BLUE CROSS BLUE SHIELD
7	625580	OTHER	FL	AETNA HMO

General Provider Information

NPI Number	:	1568466803
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JAMES WILLIAM COBB JR. O.D.

Provider Business Mailing Address
First Line	:	2186 HARRIS AVE NE
Second Line	:	STE 1
City	:	PALM BAY
State	:	FL
Zip	:	32905-4044
Country	:	US
Telephone Number	:	321-724-2020
Fax Number	:	321-724-9088

Provider Business Practice Location Address
First Line	:	2186 HARRIS AVE NE
Second Line	:	STE 1
City	:	PALM BAY
State	:	FL
Zip	:	32905-4044
Country	:	US
Telephone Number	:	321-724-2020
Fax Number	:	321-724-9088

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

Provider Enumeration Date	:	06/01/2005
Last Update Date	:	12/28/2007

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