Basic Information
| Provider Information | |||||||||
| NPI: | 1104212661 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | RAY | ||||||||
| FirstName: | COBY | ||||||||
| MiddleName: | NIELSON | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | MD, MS, MBA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 8905 JUNEAU AVE | ||||||||
| Address2: | |||||||||
| City: | LUBBOCK | ||||||||
| State: | TX | ||||||||
| PostalCode: | 794247847 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4693879921 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 3601 4TH ST # MS 7217 | ||||||||
| Address2: | |||||||||
| City: | LUBBOCK | ||||||||
| State: | TX | ||||||||
| PostalCode: | 794300002 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8067432020 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/11/2015 | ||||||||
| LastUpdateDate: | 03/23/2022 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 03/23/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207W00000X | T2478 | TX | Y | Allopathic & Osteopathic Physicians | Ophthalmology |
No ID Information.