Vincent H Coburn OD PC

Primary specialty

OptometristTaxonomy code 152W00000X

License

TO2520 Issued in MO

Legal business name

VINCENT H COBURN OD PC

Practice address

812B N One Mile Rd
Dexter, MO 63841-1034

Phone

(573) 624-8829

Fax

(573) 624-3636

NPI assigned

Jan 25, 2012

Last updated

Feb 24, 2012By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Vincent CoburnNPI 1437286747

Title

Owner

Phone

(573) 624-8829

Specialties & licenses 1

Addresses

Other identifiers 1

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Vincent Harlon Coburn, O.D.

  • Optometrist
  • Dexter, MO
  • NPI 1437286747
  Authorized official Same address or phone

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1327449600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1330041600000",
    "number": "1053682849",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "812B N ONE MILE RD",
            "city": "DEXTER",
            "state": "MO",
            "postal_code": "638411034"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "812B N ONE MILE RD",
            "city": "DEXTER",
            "state": "MO",
            "postal_code": "638411034",
            "telephone_number": "573-624-8829",
            "fax_number": "573-624-3636"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "VINCENT H COBURN OD PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-01-25",
        "last_updated": "2012-02-24",
        "status": "A",
        "authorized_official_last_name": "COBURN",
        "authorized_official_first_name": "VINCENT",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "573-624-8829"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Optometrist",
            "state": "MO",
            "license": "TO2520",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "311660906",
            "state": "MO"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Tri County Home Health, Inc. (Elara Caring)
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• April Vancil
• Ellen Vaughan, FNP
• Camellia A Vermillion, PMHNP
• Wal-Mart Stores East LP (Walmart Pharmacy 10-0030)
• Wal-Mart Stores East, LP (Vision Center 30-0030)
• Walgreen Co (Walgreens #15800)
• Emily Megan Ward
• Natasha Ware, MD

• Optometrist in Dexter, MO
• Providers in Dexter, MO by specialty
• Optometrist in Missouri

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 24, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.