Provider Demographics
NPI:1386622777
Name:COCKRELL, GILAN L (OD FAAO)
Entity type:Individual
Prefix:
First Name:GILAN
Middle Name:L
Last Name:COCKRELL
Suffix:
Gender:M
Credentials:OD FAAO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:512 COMMERCIAL ST
Mailing Address - Street 2:
Mailing Address - City:EMPORIA
Mailing Address - State:KS
Mailing Address - Zip Code:66801-4006
Mailing Address - Country:US
Mailing Address - Phone:620-343-7120
Mailing Address - Fax:620-343-2038
Practice Address - Street 1:512 COMMERCIAL ST
Practice Address - Street 2:
Practice Address - City:EMPORIA
Practice Address - State:KS
Practice Address - Zip Code:66801-4006
Practice Address - Country:US
Practice Address - Phone:620-343-7120
Practice Address - Fax:620-343-2038
Is Sole Proprietor?:No
Enumeration Date:2006-01-05
Last Update Date:2009-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS11473152W00000X
OK2183152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS100217850AMedicaid
KS410001132OtherRAILROAD MEDICARE
KS632550001OtherDMERC
KS632550001OtherDMERC
KS100217850AMedicaid