Individual
MR. GREGORY LYNN COBURN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
OD
Contact information
Practice address
4864 W BROAD STREET, COLUMBUS, OH 43228-1602
(614) 878-7771
(614) 878-4000
Mailing address
81 E GAY STREET, COLUMBUS, OH 43215-3103
(614) 224-2414
(614) 224-5916
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
3597
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0727057
—
OH
Enumeration date
07/19/2006
Last updated
07/08/2007
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