Provider Demographics
NPI:1104051630
Name:COHEN, JEFFREY MICHAEL (OD)
Entity type:Individual
Prefix:DR
First Name:JEFFREY
Middle Name:MICHAEL
Last Name:COHEN
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:1555 SIMI TOWN CENTER WAY
Mailing Address - Street 2:STE 575
Mailing Address - City:SIMI VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:93065-0535
Mailing Address - Country:US
Mailing Address - Phone:818-461-0595
Mailing Address - Fax:818-461-0596
Practice Address - Street 1:14006 RIVERSIDE DR STE 274
Practice Address - Street 2:
Practice Address - City:SHERMAN OAKS
Practice Address - State:CA
Practice Address - Zip Code:91423-1963
Practice Address - Country:US
Practice Address - Phone:818-461-0595
Practice Address - Fax:818-461-0596
Is Sole Proprietor?:No
Enumeration Date:2009-05-28
Last Update Date:2017-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOPC 4435152W00000X
CA14338152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist