Organization
ETHELRED ENTERPRISES, LLC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
COURTNEY CHEYNE COBBS OD (OWNER/MANAGING MEMBER)
(817) 408-7636
Entity
Organization
Contact information
Practice address
614 N NEW RD # 6035, WACO, TX 76710-6035
(254) 770-1338
(254) 770-1602
Mailing address
614 N NEW RD, WACO, TX 76710-6035
(254) 776-1338
(254) 751-1312
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
4923T
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
181493101
—
TX
01
—
TX4923
EYE MED
TX
Enumeration date
07/18/2008
Last updated
06/24/2009
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