Provider Demographics
NPI:1861781411
Name:THOMAS - COZAD, SHEILA LUANN (OD)
Entity type:Individual
Prefix:DR
First Name:SHEILA
Middle Name:LUANN
Last Name:THOMAS - COZAD
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2025 JONESBORO RD
Mailing Address - Street 2:
Mailing Address - City:MCDONOUGH
Mailing Address - State:GA
Mailing Address - Zip Code:30253-5971
Mailing Address - Country:US
Mailing Address - Phone:678-432-1800
Mailing Address - Fax:678-432-4500
Practice Address - Street 1:2025 JONESBORO RD
Practice Address - Street 2:
Practice Address - City:MCDONOUGH
Practice Address - State:GA
Practice Address - Zip Code:30253-5971
Practice Address - Country:US
Practice Address - Phone:678-432-1800
Practice Address - Fax:678-432-4500
Is Sole Proprietor?:Yes
Enumeration Date:2011-04-05
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAOPT001758152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA11477337OtherCAQH
GA76353OtherMEDICARE
GA76353OtherMEDICARE
GA76353OtherMEDICARE