Provider Demographics
NPI:1568083400
Name:BRENDON COX OD, LLC
Entity type:Organization
Organization Name:BRENDON COX OD, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:INCORPORATOR/OFFICER
Authorized Official - Prefix:DR
Authorized Official - First Name:BRENDON
Authorized Official - Middle Name:WARD
Authorized Official - Last Name:COX
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:417-489-5318
Mailing Address - Street 1:18688 N CREEK RD
Mailing Address - Street 2:
Mailing Address - City:LINCOLN
Mailing Address - State:AR
Mailing Address - Zip Code:72744-8609
Mailing Address - Country:US
Mailing Address - Phone:417-489-5318
Mailing Address - Fax:
Practice Address - Street 1:68 E MAIN ST
Practice Address - Street 2:
Practice Address - City:FARMINGTON
Practice Address - State:AR
Practice Address - Zip Code:72730-3110
Practice Address - Country:US
Practice Address - Phone:479-255-1010
Practice Address - Fax:479-255-1032
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-05-01
Last Update Date:2020-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR1891211025Medicaid