Individual
EMMETT DEWAYNE COSGROVE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
OD
Contact information
Practice address
11282 M140 HIGHWAY, SOUTH HAVEN, MI 49090-9405
(269) 637-1569
(269) 637-4519
Mailing address
11282 M140 HIGHWAY, SOUTH HAVEN, MI 49090-9405
(269) 637-1569
(269) 637-4519
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
002521
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
22-32002
UNITED HEALTH CARE/PHP
—
05
—
5098573
—
MI
01
—
900H06501
BLUE CROSS/BLUE SHIELD
—
Enumeration date
06/09/2005
Last updated
08/18/2008
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