Provider Demographics
NPI:1417683996
Name:COONEY, BROOKE MADISON JUSTIS (OD)
Entity Type:Individual
Prefix:DR
First Name:BROOKE
Middle Name:MADISON JUSTIS
Last Name:COONEY
Suffix:
Gender:F
Credentials:OD
Other - Prefix:DR
Other - First Name:BROOKE
Other - Middle Name:
Other - Last Name:JUSTIS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:25434 HENRYS POINT LN
Mailing Address - Street 2:
Mailing Address - City:ACCOMAC
Mailing Address - State:VA
Mailing Address - Zip Code:23301-2322
Mailing Address - Country:US
Mailing Address - Phone:757-709-9737
Mailing Address - Fax:202-331-8533
Practice Address - Street 1:900 17TH ST NW STE 400
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20006-2507
Practice Address - Country:US
Practice Address - Phone:202-331-7566
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-07-27
Last Update Date:2024-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDTA2869152W00000X
VA0618003148152W00000X
DCOP2000539152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist