Individual
GLENN M COCHRAN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
OD
Contact information
Practice address
303 S ARCHUSA AVE, QUITMAN, MS 39355-0690
(601) 776-6988
(601) 776-6989
Mailing address
PO BOX 690, QUITMAN, MS 39355-0690
(601) 776-6988
(601) 776-6989
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
488
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00087907
—
MS
Enumeration date
03/02/2006
Last updated
12/22/2011
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