Basic Information
| Provider Information | |||||||||
| NPI: | 1134272420 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | COCCIA | ||||||||
| FirstName: | THOMAS | ||||||||
| MiddleName: | RYAN | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | O.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4004 DUBLIN RD | ||||||||
| Address2: | |||||||||
| City: | WINTERVILLE | ||||||||
| State: | NC | ||||||||
| PostalCode: | 285906801 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6624889021 | ||||||||
| FaxNumber: | 2527569737 | ||||||||
| Practice Location | |||||||||
| Address1: | 12194 JOHNSTON RD STE 120 | ||||||||
| Address2: | |||||||||
| City: | CHARLOTTE | ||||||||
| State: | NC | ||||||||
| PostalCode: | 282774483 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7045416287 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 01/19/2007 | ||||||||
| LastUpdateDate: | 03/17/2018 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 152W00000X | 1406 | SC | N | Eye and Vision Services Providers | Optometrist | 152W00000X | 2254 | NC | Y | Eye and Vision Services Providers | Optometrist |
No ID Information.