Provider Demographics
NPI:1821113747
Name:COOK, TERENCE DEMITRESS (OD)
Entity Type:Individual
Prefix:DR
First Name:TERENCE
Middle Name:DEMITRESS
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 1:5128 JAMESWOOD DR
Mailing Address - Street 2:
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35244-1969
Mailing Address - Country:US
Mailing Address - Phone:205-985-7652
Mailing Address - Fax:
Practice Address - Street 1:5021 U.S. HIGHWAY 280
Practice Address - Street 2:SUITE 101
Practice Address - City:BIRMINGHAM
Practice Address - State:AL
Practice Address - Zip Code:35242
Practice Address - Country:US
Practice Address - Phone:205-995-6313
Practice Address - Fax:205-995-6314
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-20
Last Update Date:2009-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALSA62TA644152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist