Provider Demographics
NPI:1487829826
Name:COOK, MELANIE A (OPTICAN HEARING AID)
Entity Type:Individual
Prefix:
First Name:MELANIE
Middle Name:A
Last Name:COOK
Suffix:
Gender:F
Credentials:OPTICAN HEARING AID
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1908 ASHMAN STREET
Mailing Address - Street 2:
Mailing Address - City:SAULT STE MARIE
Mailing Address - State:MI
Mailing Address - Zip Code:49783
Mailing Address - Country:US
Mailing Address - Phone:906-632-2289
Mailing Address - Fax:906-632-6380
Practice Address - Street 1:1908 ASHMAN STREET
Practice Address - Street 2:
Practice Address - City:SAULT STE MARIE
Practice Address - State:MI
Practice Address - Zip Code:49783
Practice Address - Country:US
Practice Address - Phone:906-632-2289
Practice Address - Fax:906-632-6380
Is Sole Proprietor?:Yes
Enumeration Date:2008-04-28
Last Update Date:2008-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332S00000XSuppliersHearing Aid Equipment
No332H00000XSuppliersEyewear Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0850670001Medicare NSC