MEDICARE: COTTLE OPTOMETRY, PC

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	20151442	MO

General Provider Information

NPI Number	:	1689722324
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	COTTLE OPTOMETRY, PC

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	:	816-623-9449

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	:	CEO
Name	:	DR. JOHN L. COTTLE
Credential	:	O.D.
Telephone Number	:	816-623-9990

Provider Enumeration Date	:	01/08/2007
Last Update Date	:	08/12/2015

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