Provider Demographics
NPI:1417900077
Name:DAVID S COOK O.D. P.C.
Entity Type:Organization
Organization Name:DAVID S COOK O.D. P.C.
Other - Org Name:FAMILY EYE CARE ASSOCIATES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:S
Authorized Official - Last Name:COOK
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:231-775-3755
Mailing Address - Street 1:8809 PINE RIDGE DR
Mailing Address - Street 2:
Mailing Address - City:CADILLAC
Mailing Address - State:MI
Mailing Address - Zip Code:49601-1289
Mailing Address - Country:US
Mailing Address - Phone:231-775-3755
Mailing Address - Fax:231-775-1710
Practice Address - Street 1:8809 PINE RIDGE DR
Practice Address - Street 2:
Practice Address - City:CADILLAC
Practice Address - State:MI
Practice Address - Zip Code:49601-1289
Practice Address - Country:US
Practice Address - Phone:231-775-3755
Practice Address - Fax:231-775-1710
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-17
Last Update Date:2008-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4901003808152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI944610320Medicaid
MI900H310350OtherBLUE CROSS BLUE SHIELD
MI900H310350OtherBLUE CROSS BLUE SHIELD
MIU62410Medicare UPIN
MI944610320Medicaid