Provider Demographics
NPI:1033117593
Name:COOK, LEWIS C (MD)
Entity Type:Individual
Prefix:DR
First Name:LEWIS
Middle Name:C
Last Name:COOK
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2323 KENNEDY LN
Mailing Address - Street 2:
Mailing Address - City:TEXARKANA
Mailing Address - State:TX
Mailing Address - Zip Code:75503-2536
Mailing Address - Country:US
Mailing Address - Phone:903-793-2020
Mailing Address - Fax:903-793-7481
Practice Address - Street 1:2323 KENNEDY LN
Practice Address - Street 2:
Practice Address - City:TEXARKANA
Practice Address - State:TX
Practice Address - Zip Code:75503-2536
Practice Address - Country:US
Practice Address - Phone:903-793-2020
Practice Address - Fax:903-793-7481
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-07-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXE1292207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR81630OtherBCBS ARK
TX00P246Medicare ID - Type Unspecified
TXC14722Medicare UPIN