Active NPI
Gary T Coburn, O.D.
- Optometrist
- Rockville, IN
National Provider Identifier
1184771834
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Optometrist
- License
- 18001654
- Practice address
- 725 N Lincoln Road
Rockville, IN 47872 - Phone
- (765) 569-2008
- Fax
- (765) 569-2009
- NPI assigned
- Jan 4, 2007
- Last updated
- Mar 20, 2012
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Optometrist | 152W00000X | 18001654 | IN | Primary |
Addresses
Primary practice location
725 N Lincoln Road
Rockville, IN 47872
Mailing address
PO Box 278
Rockville, IN 47872-0278
Phone (765) 569-2008
Other identifiers 4
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 410046751 | Other | IN | RAILROAD MEDICARE |
| 000000264522 | Other | IN | ANTHEM PIN |
| 000000264646 | Other | IN | ANTHEM |
| 200954600 | Medicaid | IN |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 18001654 | IN | MD | Optometrist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1167868800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1332201600000",
"number": "1184771834",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 278",
"city": "ROCKVILLE",
"state": "IN",
"postal_code": "478720278",
"telephone_number": "765-569-2008",
"fax_number": "765-569-2009"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "725 N LINCOLN ROAD",
"city": "ROCKVILLE",
"state": "IN",
"postal_code": "47872",
"telephone_number": "765-569-2008",
"fax_number": "765-569-2009"
}
],
"practiceLocations": [],
"basic": {
"last_name": "COBURN",
"first_name": "GARY",
"middle_name": "T",
"name_prefix": "Dr.",
"credential": "O.D.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2007-01-04",
"last_updated": "2012-03-20",
"status": "A"
},
"taxonomies": [
{
"code": "152W00000X",
"taxonomy_group": "",
"desc": "Optometrist",
"state": "IN",
"license": "18001654",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "RAILROAD MEDICARE",
"identifier": "410046751",
"state": "IN"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "ANTHEM PIN",
"identifier": "000000264522",
"state": "IN"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "ANTHEM",
"identifier": "000000264646",
"state": "IN"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "200954600",
"state": "IN"
}
],
"endpoints": [],
"other_names": []
}Other providers in Rockville, IN
- Child-Adult Resource Services, Inc
- Child-Adult Resource Services, Inc.
- Child-Adult Resource Services, Inc.
- Katherine E Chobanov, DO
- Melissa Kay Clark, FNP-C
- Community Health Intervention and Education Foundation Incorporated (Family Health & Help Center)
- Daviess County Hospital (Rockville Nursing and Rehabilitation)
- Desiree Davis, LMHC
- Dna Harrison Enterprises (Comfort Keepers 556)
- Daniel J Dwyer, MD
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 20, 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.