Provider Demographics
NPI:1194745729
Name:COCKE, DANA ANTHONY (OD)
Entity type:Individual
Prefix:DR
First Name:DANA
Middle Name:ANTHONY
Last Name:COCKE
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5003 TACOMA MALL BLVD STE 102
Mailing Address - Street 2:
Mailing Address - City:TACOMA
Mailing Address - State:WA
Mailing Address - Zip Code:98409-7120
Mailing Address - Country:US
Mailing Address - Phone:253-472-5813
Mailing Address - Fax:253-472-0640
Practice Address - Street 1:5003 TACOMA MALL BLVD STE 102
Practice Address - Street 2:
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98409-7120
Practice Address - Country:US
Practice Address - Phone:253-472-5813
Practice Address - Fax:253-472-0640
Is Sole Proprietor?:No
Enumeration Date:2006-07-19
Last Update Date:2008-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA3140152WC0802X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152WC0802XEye and Vision Services ProvidersOptometristCorneal and Contact Management
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA2019289Medicaid
WAG8800994Medicare PIN
WA2019289Medicaid