Provider Demographics
NPI:1285938621
Name:DRS ODOM COBURN AND RICHARDSON PLLC
Entity type:Organization
Organization Name:DRS ODOM COBURN AND RICHARDSON PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:
Authorized Official - Last Name:COBURN
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:918-682-7752
Mailing Address - Street 1:742 N YORK ST
Mailing Address - Street 2:
Mailing Address - City:MUSKOGEE
Mailing Address - State:OK
Mailing Address - Zip Code:74403-3866
Mailing Address - Country:US
Mailing Address - Phone:918-682-7752
Mailing Address - Fax:
Practice Address - Street 1:742 N YORK ST
Practice Address - Street 2:
Practice Address - City:MUSKOGEE
Practice Address - State:OK
Practice Address - Zip Code:74403-3866
Practice Address - Country:US
Practice Address - Phone:186-827-7529
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-12-28
Last Update Date:2024-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK6416960001Medicare NSC
OKOKA101431Medicare PIN