Provider Demographics
NPI:1215031372
Name:COOK, BARRY PAUL (OD)
Entity Type:Individual
Prefix:DR
First Name:BARRY
Middle Name:PAUL
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 1:92 NORTH 400 EAST
Mailing Address - Street 2:
Mailing Address - City:PRICE
Mailing Address - State:UT
Mailing Address - Zip Code:84501
Mailing Address - Country:US
Mailing Address - Phone:435-637-6290
Mailing Address - Fax:435-637-6291
Practice Address - Street 1:92 NORTH 400 EAST
Practice Address - Street 2:
Practice Address - City:PRICE
Practice Address - State:UT
Practice Address - Zip Code:84501
Practice Address - Country:US
Practice Address - Phone:435-637-6290
Practice Address - Fax:435-637-6291
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-11
Last Update Date:2014-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT328152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
T78147Medicare UPIN
UT0504420001Medicare NSC
UTP01053645Medicare PIN
000009560Medicare ID - Type Unspecified