Provider Demographics
NPI:1639582901
Name:COOK, LUCAS A
Entity Type:Individual
Prefix:
First Name:LUCAS
Middle Name:A
Last Name:COOK
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:LUCAS
Other - Middle Name:ANDREW
Other - Last Name:COOK
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:OD
Mailing Address - Street 1:4150 KIMBALL AVE
Mailing Address - Street 2:PO BOX 2758
Mailing Address - City:WATERLOO
Mailing Address - State:IA
Mailing Address - Zip Code:50701-9086
Mailing Address - Country:US
Mailing Address - Phone:319-235-5390
Mailing Address - Fax:319-235-5607
Practice Address - Street 1:909 E SAN MARNAN DR
Practice Address - Street 2:
Practice Address - City:WATERLOO
Practice Address - State:IA
Practice Address - Zip Code:50702-5611
Practice Address - Country:US
Practice Address - Phone:319-233-2020
Practice Address - Fax:319-234-1939
Is Sole Proprietor?:No
Enumeration Date:2014-06-04
Last Update Date:2022-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA073303152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist