MEDICARE: DR JAMES W COBB, JR, PA

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

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	34850	OTHER	FL	BLUE CROSS BLUE SHIELD
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1568510816
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DR JAMES W COBB, JR, PA

Provider Business Mailing Address
First Line	:	2186 HARRIS AVE NE
Second Line	:	SUITE 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	:	SUITE 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	:	PRESIDENT
Name	:	DR. JAMES W COBB JR.
Credential	:	O.D.
Telephone Number	:	321-724-2020

Provider Enumeration Date	:	01/05/2007
Last Update Date	:	01/04/2008

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