Provider Demographics
NPI:1477593564
Name:COOK, LYMAN D (OD)
Entity Type:Individual
Prefix:DR
First Name:LYMAN
Middle Name:D
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 1:1724 W KEARNEY ST
Mailing Address - Street 2:SUITE 116
Mailing Address - City:SPRINGFIELD
Mailing Address - State:MO
Mailing Address - Zip Code:65803-1645
Mailing Address - Country:US
Mailing Address - Phone:417-865-4448
Mailing Address - Fax:417-862-8704
Practice Address - Street 1:1724 W KEARNEY ST
Practice Address - Street 2:SUITE 116
Practice Address - City:SPRINGFIELD
Practice Address - State:MO
Practice Address - Zip Code:65803-1645
Practice Address - Country:US
Practice Address - Phone:417-865-4448
Practice Address - Fax:417-862-8704
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-07
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOT02432152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO157403OtherBLUE CROSS BLUE SHIELD
MO43141947565803A002OtherTRI WEST
MOAF26850OtherSPECTERA
MOMO2432OtherEYEMED VISION CARE
MO4178654448OtherVISION SERVICE PLAN
MO4178654448OtherVISION SERVICE PLAN
MO157403OtherBLUE CROSS BLUE SHIELD