MEDICARE: RAYMOND WAYNE COBB JR. OD

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	S769TA002	AL

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	000058646	OTHER	AL	MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1669463972
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RAYMOND WAYNE COBB JR. OD

Provider Business Mailing Address
First Line	:	PO BOX 2087
Second Line	:
City	:	HAMILTON
State	:	AL
Zip	:	35570-2087
Country	:	US
Telephone Number	:	205-921-5499
Fax Number	:	205-921-0691

Provider Business Practice Location Address
First Line	:	1520 MILITARY ST S
Second Line	:
City	:	HAMILTON
State	:	AL
Zip	:	35570-5006
Country	:	US
Telephone Number	:	205-921-5499
Fax Number	:	205-921-0691

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

Provider Enumeration Date	:	11/04/2005
Last Update Date	:	07/21/2022

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