Basic Information
| Provider Information | |||||||||
| NPI: | 1457436636 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | COHEN | ||||||||
| FirstName: | DAVID | ||||||||
| MiddleName: | MARC | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | O.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 12409 MCALLISTER PARK DR | ||||||||
| Address2: | |||||||||
| City: | CHARLOTTE | ||||||||
| State: | NC | ||||||||
| PostalCode: | 282772495 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7047523727 | ||||||||
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| Practice Location | |||||||||
| Address1: | 2301 DAVE LYLE BLVD STE 101 | ||||||||
| Address2: | |||||||||
| City: | ROCK HILL | ||||||||
| State: | SC | ||||||||
| PostalCode: | 297306294 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8033296464 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 10/26/2006 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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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 | 1221 | SC | Y | Eye and Vision Services Providers | Optometrist |
No ID Information.