Individual
MR. JERRY K COBURN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
OD
Contact information
Practice address
742 N YORK ST, MUSKOGEE, OK 74403-3866
(918) 682-7752
(918) 687-8440
Mailing address
742 N YORK ST, MUSKOGEE, OK 74403-3866
(918) 682-7752
(918) 687-8440
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
956
OK
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100766490A
—
OK
Enumeration date
03/07/2006
Last updated
07/08/2010
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