Provider Demographics
NPI:1942518568
Name:BARRY P COOK OD PC
Entity Type:Organization
Organization Name:BARRY P COOK OD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPTOMETRIC PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:BARRY
Authorized Official - Middle Name:PAUL
Authorized Official - Last Name:COOK
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:435-637-6290
Mailing Address - Street 1:92 N 400 E
Mailing Address - Street 2:
Mailing Address - City:PRICE
Mailing Address - State:UT
Mailing Address - Zip Code:84501-2509
Mailing Address - Country:US
Mailing Address - Phone:435-637-6290
Mailing Address - Fax:435-637-6291
Practice Address - Street 1:92 N 400 E
Practice Address - Street 2:
Practice Address - City:PRICE
Practice Address - State:UT
Practice Address - Zip Code:84501-2509
Practice Address - Country:US
Practice Address - Phone:435-637-6290
Practice Address - Fax:435-637-6291
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-09-16
Last Update Date:2010-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UTU0328152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT529703429007Medicaid
UTU000009560Medicare PIN