Provider Demographics
NPI:1538168836
Name:COCHRAN, JOHN BARRY
Entity type:Individual
Prefix:
First Name:JOHN
Middle Name:BARRY
Last Name:COCHRAN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2518 N MCMULLEN BOOTH RD
Mailing Address - Street 2:SUITE C
Mailing Address - City:CLEARWATER
Mailing Address - State:FL
Mailing Address - Zip Code:33761-4184
Mailing Address - Country:US
Mailing Address - Phone:727-725-5558
Mailing Address - Fax:727-724-3966
Practice Address - Street 1:2518 N MCMULLEN BOOTH RD
Practice Address - Street 2:SUITE C
Practice Address - City:CLEARWATER
Practice Address - State:FL
Practice Address - Zip Code:33761-4184
Practice Address - Country:US
Practice Address - Phone:727-725-5558
Practice Address - Fax:727-724-3966
Is Sole Proprietor?:No
Enumeration Date:2005-07-19
Last Update Date:2009-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL1821152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
112485OtherECPA/EYEMED
112485OtherECPA/EYEMED
19431Medicare ID - Type Unspecified