Provider Demographics
NPI:1851349666
Name:COOK, PAUL HUIE JR (O D)
Entity Type:Individual
Prefix:DR
First Name:PAUL
Middle Name:HUIE
Last Name:COOK
Suffix:JR
Gender:M
Credentials:O D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 2700
Mailing Address - Street 2:620 MAIN ST.
Mailing Address - City:FRISCO
Mailing Address - State:CO
Mailing Address - Zip Code:80443-2700
Mailing Address - Country:US
Mailing Address - Phone:970-668-2020
Mailing Address - Fax:970-668-0192
Practice Address - Street 1:620 MAIN ST.
Practice Address - Street 2:
Practice Address - City:FRISCO
Practice Address - State:CO
Practice Address - Zip Code:80443-2700
Practice Address - Country:US
Practice Address - Phone:970-668-2020
Practice Address - Fax:970-668-0192
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO1085152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO08010852Medicaid
CO08010852Medicaid
COT60887Medicare UPIN