Provider Demographics
NPI:1861588790
Name:ROOK, NIKKI (OD)
Entity type:Individual
Prefix:
First Name:NIKKI
Middle Name:
Last Name:ROOK
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:327 SPRINGBROOK DR
Mailing Address - Street 2:
Mailing Address - City:CANTON
Mailing Address - State:PA
Mailing Address - Zip Code:17724-7896
Mailing Address - Country:US
Mailing Address - Phone:570-673-8390
Mailing Address - Fax:570-673-4606
Practice Address - Street 1:327 SPRINGBROOK DR
Practice Address - Street 2:
Practice Address - City:CANTON
Practice Address - State:PA
Practice Address - Zip Code:17724-7896
Practice Address - Country:US
Practice Address - Phone:570-673-8390
Practice Address - Fax:570-673-4606
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-05
Last Update Date:2014-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA0EG000540152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA112816Medicare PIN
PA5809990001Medicare NSC