Organization
COCOS SHOE STORE INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
ROBERT J COCO PEDORTHIST (PRESIDENT)
(337) 439-4751
Entity
Organization
Contact information
Practice address
2314 RYAN ST, LAKE CHARLES, LA 70601-7320
(337) 439-4751
(337) 439-1395
Mailing address
2314 RYAN ST, LAKE CHARLES, LA 70601-7320
(337) 439-4751
(337) 439-1395
Taxonomy
Speciality
Code
Description
License number
State
335E00000X
Prosthetic/Orthotic Supplier
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1392383
—
LA
Enumeration date
01/09/2007
Last updated
03/11/2008
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