Provider Demographics
NPI:1538113683
Name:COOK, STEPHEN A (OD)
Entity Type:Individual
Prefix:DR
First Name:STEPHEN
Middle Name:A
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 1:5721 ESPLANADE DR
Mailing Address - Street 2:
Mailing Address - City:CORPUS CHRISTI
Mailing Address - State:TX
Mailing Address - Zip Code:78414-4138
Mailing Address - Country:US
Mailing Address - Phone:361-334-2625
Mailing Address - Fax:
Practice Address - Street 1:601 E RUSSELL AVE
Practice Address - Street 2:
Practice Address - City:WARRENSBURG
Practice Address - State:MO
Practice Address - Zip Code:64093-9605
Practice Address - Country:US
Practice Address - Phone:660-747-2020
Practice Address - Fax:660-747-0574
Is Sole Proprietor?:No
Enumeration Date:2006-05-22
Last Update Date:2017-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOT02785152WC0802X
TX9173T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
No152WC0802XEye and Vision Services ProvidersOptometristCorneal and Contact Management
Provider Identifiers
StateIdentifier IDID TypeIssuer
MOT95951Medicare UPIN