Emmett Dewayne Cosgrove, OD

Primary specialty

OptometristTaxonomy code 152W00000X

License

002521 Issued in MI

Practice address

11282 M140 Highway
South Haven, MI 49090-9405

Phone

(269) 637-1569

Fax

(269) 637-4519

NPI assigned

Jun 9, 2005

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Other identifiers 3

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

State licenses

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

{
    "created_epoch": "1118275200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1219017600000",
    "number": "1316941255",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "11282 M140 HIGHWAY",
            "city": "SOUTH HAVEN",
            "state": "MI",
            "postal_code": "490909405",
            "telephone_number": "269-637-1569",
            "fax_number": "269-637-4519"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11282 M140 HIGHWAY",
            "city": "SOUTH HAVEN",
            "state": "MI",
            "postal_code": "490909405",
            "telephone_number": "269-637-1569",
            "fax_number": "269-637-4519"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "COSGROVE",
        "first_name": "EMMETT",
        "middle_name": "DEWAYNE",
        "credential": "OD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2005-06-09",
        "last_updated": "2008-08-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "MI",
            "license": "002521",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "UNITED HEALTH CARE/PHP",
            "identifier": "22-32002",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS/BLUE SHIELD",
            "identifier": "900H06501",
            "state": null
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "5098573",
            "state": "MI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Cardiology II, P.C.
• Holly Carrizales, CNP
• Allan D Caudill, MD
• Ian Laurence Clark, MD
• Hailey Conklin, LMSW
• Gabriela Crider
• Mary Grace Crock-Ring, R.N.
• Ralph Cunningham, MA,LLPC,ADA
• Melissa Marie Cutler
• Sharon Davis

• Optometrist in South Haven, MI
• Providers in South Haven, MI by specialty
• Optometrist in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 18, 2008; 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.