MEDICARE: KATHERINE DIANNE COX 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	1119T	GA
2	152W00000X	Optometrist	920T	TN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	0116122	OTHER	GA	BLUECROSSBLUESHIELD
2	0845880002	OTHER	GA	DMERC
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1760523948
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KATHERINE DIANNE COX O.D.

Provider Business Mailing Address
First Line	:	1670 BATTLEFIELD PKWY
Second Line	:
City	:	FT OGLETHORPE
State	:	GA
Zip	:	30742-4046
Country	:	US
Telephone Number	:	706-866-2111
Fax Number	:	706-866-5363

Provider Business Practice Location Address
First Line	:	1670 BATTLEFIELD PKWY
Second Line	:
City	:	FT OGLETHORPE
State	:	GA
Zip	:	30742-4046
Country	:	US
Telephone Number	:	706-866-2111
Fax Number	:	706-866-5363

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

Provider Enumeration Date	:	02/09/2007
Last Update Date	:	07/08/2007

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