Organization
COCHRAN OPTICAL DISPENSARY
Active
Organization subpart
No
Provider details
NPI number
Authorized official
GARY A COCHRAN (OWNER)
(662) 289-9581
Entity
Organization
Contact information
Practice address
118 W NORTH ST, KOSCIUSKO, MS 39090-3211
(662) 289-9581
(662) 289-9967
Mailing address
PO BOX 960, KOSCIUSKO, MS 39090-0960
(662) 289-9581
(662) 289-9967
Taxonomy
Speciality
Code
Description
License number
State
332H00000X
Eyewear Supplier
Primary
056063
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00089021
—
MS
Enumeration date
02/21/2008
Last updated
06/11/2008
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