Provider Demographics
NPI:1568466803
Name:COBB, JAMES WILLIAM JR (OD)
Entity type:Individual
Prefix:
First Name:JAMES
Middle Name:WILLIAM
Last Name:COBB
Suffix:JR
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2186 HARRIS AVE NE
Mailing Address - Street 2:STE 1
Mailing Address - City:PALM BAY
Mailing Address - State:FL
Mailing Address - Zip Code:32905-4044
Mailing Address - Country:US
Mailing Address - Phone:321-724-2020
Mailing Address - Fax:321-724-9088
Practice Address - Street 1:2186 HARRIS AVE NE
Practice Address - Street 2:STE 1
Practice Address - City:PALM BAY
Practice Address - State:FL
Practice Address - Zip Code:32905-4044
Practice Address - Country:US
Practice Address - Phone:321-724-2020
Practice Address - Fax:321-724-9088
Is Sole Proprietor?:No
Enumeration Date:2005-06-01
Last Update Date:2007-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOPC 974152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL048031001OtherDMERC
FL7147100OtherCIGNA
FL4497605OtherAETNA PPO
FL084742900Medicaid
FL19549OtherBLUE CROSS BLUE SHIELD
FL580098649OtherRAILROAD MEDICARE
FL625580OtherAETNA HMO
FLT84044Medicare UPIN
FL19549ZMedicare ID - Type Unspecified
FL084742900Medicaid