Provider Demographics
NPI:1164411310
Name:COOK, CHRISTINE WARE (FAAO)
Entity Type:Individual
Prefix:DR
First Name:CHRISTINE
Middle Name:WARE
Last Name:COOK
Suffix:
Gender:F
Credentials:FAAO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:813 INDEPENDENCE BLVD
Mailing Address - Street 2:
Mailing Address - City:VIRGINIA BEACH
Mailing Address - State:VA
Mailing Address - Zip Code:23455-6004
Mailing Address - Country:US
Mailing Address - Phone:757-490-9091
Mailing Address - Fax:757-490-3250
Practice Address - Street 1:813 INDEPENDENCE BLVD
Practice Address - Street 2:
Practice Address - City:VIRGINIA BEACH
Practice Address - State:VA
Practice Address - Zip Code:23455-6004
Practice Address - Country:US
Practice Address - Phone:757-490-9091
Practice Address - Fax:757-490-3250
Is Sole Proprietor?:No
Enumeration Date:2005-10-20
Last Update Date:2010-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0618000757152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA337489OtherANTHEM BLUE CROSS
VA009234802Medicaid
VA541206650OtherTRICARE
VA0761520001OtherDMERC CIGNA GOVERNMENT SERVICES
VA009234802Medicaid
VA0761520001Medicare NSC
VAU77121Medicare UPIN