Provider Demographics
NPI:1306978044
Name:COCKRELL EYECARE CENTER
Entity type:Organization
Organization Name:COCKRELL EYECARE CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:A
Authorized Official - Last Name:COCKRELL
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:405-372-1715
Mailing Address - Street 1:1711 W 6TH
Mailing Address - Street 2:
Mailing Address - City:STILLWATER
Mailing Address - State:OK
Mailing Address - Zip Code:74074-4200
Mailing Address - Country:US
Mailing Address - Phone:405-372-1715
Mailing Address - Fax:405-372-3350
Practice Address - Street 1:1711 W 6TH
Practice Address - Street 2:
Practice Address - City:STILLWATER
Practice Address - State:OK
Practice Address - Zip Code:74074-4200
Practice Address - Country:US
Practice Address - Phone:405-372-1715
Practice Address - Fax:405-372-3350
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-09
Last Update Date:2010-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK100768620CMedicaid
C05037OtherRAILROAD MEDICARE
600522009Medicare PIN
0234770001Medicare NSC