Provider Demographics
NPI:1316052533
Name:COBB, D. BRADLEY (OD)
Entity type:Individual
Prefix:
First Name:D. BRADLEY
Middle Name:
Last Name:COBB
Suffix:
Gender:M
Credentials:OD
Other - Prefix:DR
Other - First Name:D. BRADLEY
Other - Middle Name:
Other - Last Name:COBB
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:OD
Mailing Address - Street 1:4037 NOWATA RD
Mailing Address - Street 2:
Mailing Address - City:BARTLESVILLE
Mailing Address - State:OK
Mailing Address - Zip Code:74006-5118
Mailing Address - Country:US
Mailing Address - Phone:918-333-8989
Mailing Address - Fax:918-333-8991
Practice Address - Street 1:4037 NOWATA RD
Practice Address - Street 2:
Practice Address - City:BARTLESVILLE
Practice Address - State:OK
Practice Address - Zip Code:74006-5118
Practice Address - Country:US
Practice Address - Phone:918-333-8989
Practice Address - Fax:918-333-8991
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-20
Last Update Date:2020-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK2095152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK100765640AMedicaid
OKP00409517OtherRAILROAD MEDICARE
OK$$$$$$$$$002OtherBLUE CROSS BLUE SHIELD
OKP00409517OtherRAILROAD MEDICARE
OKU44735Medicare UPIN
OK5821650001Medicare NSC