Organization
VINCENT H COBURN OD PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
VINCENT COBURN (OWNER)
(573) 624-8829
Entity
Organization
Contact information
Practice address
812B N ONE MILE RD, DEXTER, MO 63841-1034
(573) 624-8829
(573) 624-3636
Mailing address
812B N ONE MILE RD, DEXTER, MO 63841-1034
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
TO2520
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
311660906
—
MO
Enumeration date
01/25/2012
Last updated
02/24/2012
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