Mallie Lena Cockerham

Primary specialty

OpticianTaxonomy code 156FX1800X

Practice address

2900 Towne Blvd
Middletown, OH 45044-6200

Phone

(513) 423-5869

Fax

(513) 423-6498

NPI assigned

Feb 13, 2023

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Other names 1

• Miss Mallie Lena Collinsworth Former name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

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

{
    "created_epoch": "1676246400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1676246400000",
    "number": "1578260220",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2900 TOWNE BLVD",
            "city": "MIDDLETOWN",
            "state": "OH",
            "postal_code": "450446200",
            "telephone_number": "513-423-5869",
            "fax_number": "513-423-6498"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2900 TOWNE BLVD",
            "city": "MIDDLETOWN",
            "state": "OH",
            "postal_code": "450446200",
            "telephone_number": "513-423-5869",
            "fax_number": "513-423-6498"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "COCKERHAM",
        "first_name": "MALLIE",
        "middle_name": "LENA",
        "name_prefix": "Mrs.",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2023-02-13",
        "last_updated": "2023-02-13",
        "certification_date": "2023-02-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "156FX1800X",
            "taxonomy_group": "",
            "desc": "Technician/Technologist, Optician",
            "state": "OH",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "MALLIE",
            "last_name": "COLLINSWORTH",
            "middle_name": "LENA",
            "prefix": "MISS",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Suzanne Clark, AU.D.
• Jami Clarke
• Carol A Clemow
• Close to Home II, LLC
• Gary Arthur Cobb, M.D.
• Katie V. Cohen, CH
• Kelly M Cole, LISW
• Renee Lynn Cole
• Kayley Coletta, MS CF-SLP
• Alisa Renee Collins, LSW

• Optician in Middletown, OH
• Providers in Middletown, OH by specialty
• Optician in Ohio

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 13, 2023; 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.