Provider Demographics
NPI:1407856735
Name:COHN, MARK H (OD)
Entity type:Individual
Prefix:DR
First Name:MARK
Middle Name:H
Last Name:COHN
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Mailing Address - Street 1:15650 NE 24TH ST
Mailing Address - Street 2:SUITE B
Mailing Address - City:BELLEVUE
Mailing Address - State:WA
Mailing Address - Zip Code:98008-2460
Mailing Address - Country:US
Mailing Address - Phone:425-746-9914
Mailing Address - Fax:425-746-9916
Practice Address - Street 1:15650 NE 24TH ST
Practice Address - Street 2:SUITE B
Practice Address - City:BELLEVUE
Practice Address - State:WA
Practice Address - Zip Code:98008-2460
Practice Address - Country:US
Practice Address - Phone:425-746-9914
Practice Address - Fax:425-746-9916
Is Sole Proprietor?:No
Enumeration Date:2005-07-28
Last Update Date:2010-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAOD00001034152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA2013423Medicaid
T01563Medicare UPIN
WAG000100988Medicare ID - Type Unspecified