Provider Demographics
NPI:1174554562
Name:COHEN, HOWARD B (OD)
Entity type:Individual
Prefix:DR
First Name:HOWARD
Middle Name:B
Last Name:COHEN
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:1950 OLD GALLOWS RD 520
Mailing Address - Street 2:
Mailing Address - City:VIENNA
Mailing Address - State:VA
Mailing Address - Zip Code:22182-3970
Mailing Address - Country:US
Mailing Address - Phone:703-847-8899
Mailing Address - Fax:703-991-0514
Practice Address - Street 1:2955 CRAIN HIGHWAY
Practice Address - Street 2:SUITE A&B
Practice Address - City:WALDORF
Practice Address - State:MD
Practice Address - Zip Code:20601
Practice Address - Country:US
Practice Address - Phone:301-645-3600
Practice Address - Fax:301-870-9415
Is Sole Proprietor?:No
Enumeration Date:2006-07-05
Last Update Date:2018-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0618001431152W00000X
DCOP483152W00000X
MDTA0785152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDT59929Medicare UPIN
MD747L681DMedicare PIN
DC000K01E22Medicare PIN