Provider Demographics
NPI:1144373473
Name:COCCIA VISION CARE
Entity type:Organization
Organization Name:COCCIA VISION CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:RYAN
Authorized Official - Last Name:COCCIA
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:662-488-9021
Mailing Address - Street 1:103 SCENIC CV
Mailing Address - Street 2:
Mailing Address - City:SALTILLO
Mailing Address - State:MS
Mailing Address - Zip Code:38866-7950
Mailing Address - Country:US
Mailing Address - Phone:662-648-9285
Mailing Address - Fax:
Practice Address - Street 1:100 MCCORD ROAD
Practice Address - Street 2:
Practice Address - City:PONTOTOC
Practice Address - State:MS
Practice Address - Zip Code:38863
Practice Address - Country:US
Practice Address - Phone:662-488-9021
Practice Address - Fax:662-488-9022
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-19
Last Update Date:2010-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS739152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS54185OtherDAVIS VISION
MSMS0739OtherEYEMED
MS04775008Medicaid
MS42631OtherSPECTERA
MSMS0739OtherEYEMED
MS42631OtherSPECTERA
MS=========OtherACCLAIM
MS=========OtherBLUE CROSS BLUE SHIELD
MSC04589Medicare PIN