Provider Demographics
NPI:1790059160
Name:COOK, LEE (LDO)
Entity Type:Individual
Prefix:MR
First Name:LEE
Middle Name:
Last Name:COOK
Suffix:
Gender:M
Credentials:LDO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2025 PEACHTREE RD NE
Mailing Address - Street 2:SUITE 1121
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30309-1413
Mailing Address - Country:US
Mailing Address - Phone:678-463-0868
Mailing Address - Fax:
Practice Address - Street 1:2025 PEACHTREE RD NE
Practice Address - Street 2:SUITE 1121
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30309-1413
Practice Address - Country:US
Practice Address - Phone:678-463-0868
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-03-02
Last Update Date:2012-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAGA001342156FC0800X, 156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician
No156FC0800XEye and Vision Services ProvidersTechnician/TechnologistContact Lens
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAGA001342OtherLICENSED DISPENSING OPTICIAN