Provider Demographics
NPI:1962692822
Name:COCHERAN, JUSTIN (OD)
Entity type:Individual
Prefix:DR
First Name:JUSTIN
Middle Name:
Last Name:COCHERAN
Suffix:
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 1:802 W PETREE RD
Mailing Address - Street 2:
Mailing Address - City:ANADARKO
Mailing Address - State:OK
Mailing Address - Zip Code:73005-6026
Mailing Address - Country:US
Mailing Address - Phone:405-326-3942
Mailing Address - Fax:
Practice Address - Street 1:802 W PETREE RD
Practice Address - Street 2:
Practice Address - City:ANADARKO
Practice Address - State:OK
Practice Address - Zip Code:73005-6026
Practice Address - Country:US
Practice Address - Phone:405-326-3942
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-07-26
Last Update Date:2007-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK2518152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist