Organization
GREAT BASIN EYECARE, PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. KELLY J COCHRANE OD (OWNER)
(509) 547-6998
Entity
Organization
Contact information
Practice address
9825 SANDIFUR PKWY, SUITE B, PASCO, WA 99301-6738
(509) 547-6998
(509) 547-6966
Mailing address
PO BOX 4013, PASCO, WA 99302-4013
(509) 547-6998
(509) 547-6966
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
OD1536TX
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0226424
DEPT. LABOR AND INDUSTRIE
WA
Enumeration date
12/04/2007
Last updated
12/04/2007
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