Provider Demographics
NPI:1477679488
Name:COOK, DAVID L (OD)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:L
Last Name:COOK
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:1395 S MARIETTA PKWY SE
Mailing Address - Street 2:BLD. 400, STE. 116
Mailing Address - City:MARIETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30067-4440
Mailing Address - Country:US
Mailing Address - Phone:770-419-0400
Mailing Address - Fax:
Practice Address - Street 1:1395 S MARIETTA PKWY SE
Practice Address - Street 2:BLD. 400, STE. 116
Practice Address - City:MARIETTA
Practice Address - State:GA
Practice Address - Zip Code:30067-4440
Practice Address - Country:US
Practice Address - Phone:770-419-0400
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA000932152WV0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152WV0400XEye and Vision Services ProvidersOptometristVision Therapy