Provider Demographics
NPI:1326035544
Name:COOK, RITA DEBBIE (OD)
Entity Type:Individual
Prefix:DR
First Name:RITA
Middle Name:DEBBIE
Last Name:COOK
Suffix:
Gender:F
Credentials:OD
Other - Prefix:DR
Other - First Name:RITA
Other - Middle Name:DEBBIE
Other - Last Name:WALLACE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OD
Mailing Address - Street 1:14667 SW TEAL BLVD
Mailing Address - Street 2:
Mailing Address - City:BEAVERTON
Mailing Address - State:OR
Mailing Address - Zip Code:97007-6194
Mailing Address - Country:US
Mailing Address - Phone:503-579-2020
Mailing Address - Fax:503-579-0404
Practice Address - Street 1:14667 SW TEAL BLVD
Practice Address - Street 2:
Practice Address - City:BEAVERTON
Practice Address - State:OR
Practice Address - Zip Code:97007-6194
Practice Address - Country:US
Practice Address - Phone:503-579-2020
Practice Address - Fax:503-579-0404
Is Sole Proprietor?:No
Enumeration Date:2005-10-03
Last Update Date:2013-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR2976AT152W00000X, 152WC0802X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
No152WC0802XEye and Vision Services ProvidersOptometristCorneal and Contact Management
Provider Identifiers
StateIdentifier IDID TypeIssuer
V00953Medicare UPIN
120513Medicare PIN