Basic Information
| Provider Information | |||||||||
| NPI: | 1013308634 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | COCHRAN | ||||||||
| FirstName: | MEGAN | ||||||||
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| Credential: | STUDENT | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1040 DELAWARE AVE | ||||||||
| Address2: | |||||||||
| City: | MARION | ||||||||
| State: | OH | ||||||||
| PostalCode: | 433026416 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7403838050 | ||||||||
| FaxNumber: | 7403837084 | ||||||||
| Practice Location | |||||||||
| Address1: | 5100 W BROAD ST | ||||||||
| Address2: | |||||||||
| City: | COLUMBUS | ||||||||
| State: | OH | ||||||||
| PostalCode: | 432281607 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6145441000 | ||||||||
| FaxNumber: | 6145441751 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/18/2015 | ||||||||
| LastUpdateDate: | 04/21/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 04/21/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207W00000X | 34.013778 | OH | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Ophthalmology |
ID Information
| ID | Type | State | Issuer | Description | 0148377 | 05 | OH | MEDICAID |