Basic Information
| Provider Information | |||||||||
| NPI: | 1861572075 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | COCHRAN | ||||||||
| FirstName: | JOHN | ||||||||
| MiddleName: | L | ||||||||
| NamePrefix: | |||||||||
| NameSuffix: | |||||||||
| Credential: | OD | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | |||||||||
| OtherFirstName: | |||||||||
| OtherMiddleName: | |||||||||
| OtherNamePrefix: | |||||||||
| OtherNameSuffix: | |||||||||
| OtherCredential: | |||||||||
| OtherLastNameType: | |||||||||
| Mailing Information | |||||||||
| Address1: | 13320 FRANKLIN FARM RD STE H | ||||||||
| Address2: | |||||||||
| City: | HERNDON | ||||||||
| State: | VA | ||||||||
| PostalCode: | 201714097 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7034815600 | ||||||||
| FaxNumber: | 7034374137 | ||||||||
| Practice Location | |||||||||
| Address1: | 13320 FRANKLIN FARM RD STE H | ||||||||
| Address2: | |||||||||
| City: | HERNDON | ||||||||
| State: | VA | ||||||||
| PostalCode: | 201714097 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7034815600 | ||||||||
| FaxNumber: | 7034374137 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/16/2006 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
| NPIDeactivationReasonCode: | |||||||||
| NPIDeactivationDate: | |||||||||
| NPIReactivationDate: | |||||||||
| ProviderGenderCode: | M | ||||||||
| AuthorizedOfficialLastName: | |||||||||
| AuthorizedOfficialFirstName: | |||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | |||||||||
| AuthorizedOfficialTelephone: | |||||||||
| IsSoleProprietor: | N | ||||||||
| IsOrganizationSubpart: | |||||||||
| ParentOrganizationLBN: | |||||||||
| AuthorizedOfficialNamePrefix: | |||||||||
| AuthorizedOfficialNameSuffix: | |||||||||
| AuthorizedOfficialCredential: | |||||||||
| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 152W00000X | 0618000381 | VA | Y | Eye and Vision Services Providers | Optometrist |
ID Information
| ID | Type | State | Issuer | Description | AP4203 | 01 | VA | DAVIS VISION | OTHER | 178389 | 01 | VA | ANTHEM | OTHER | 2129615 | 01 | VA | MAMSI | OTHER | VA0922 | 01 | VA | EYEMED | OTHER | 09721 | 01 | VA | SPECTERA | OTHER | 12436 | 01 | VA | AVESIS | OTHER | 4609512 | 01 | VA | AETNA PPO | OTHER | G9450001 | 01 | VA | CARE FIRST | OTHER | 0009237666 | 05 | VA | MEDICAID | 487204 | 01 | VA | NVA | OTHER | VA00922 | 01 | VA | VBA | OTHER | 1519001 | 01 | VA | CIGNA | OTHER |