Provider Demographics
NPI:1780753749
Name:COOK, DAVID S (OD)
Entity type:Individual
Prefix:DR
First Name:DAVID
Middle Name:S
Last Name:COOK
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8809 PINE RIDGE DR
Mailing Address - Street 2:
Mailing Address - City:CADILLAC
Mailing Address - State:MI
Mailing Address - Zip Code:49601-1289
Mailing Address - Country:US
Mailing Address - Phone:231-775-3755
Mailing Address - Fax:231-775-1710
Practice Address - Street 1:8809 PINE RIDGE DR
Practice Address - Street 2:
Practice Address - City:CADILLAC
Practice Address - State:MI
Practice Address - Zip Code:49601-1289
Practice Address - Country:US
Practice Address - Phone:231-775-3755
Practice Address - Fax:231-775-1710
Is Sole Proprietor?:No
Enumeration Date:2006-11-06
Last Update Date:2008-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4901003808152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIDC003808OtherBLUE CROSS BLUE SHIELD
MI944610320Medicaid
MIU62410Medicare UPIN
MIDC003808OtherBLUE CROSS BLUE SHIELD
MI5008090001Medicare NSC