Provider Demographics
NPI:1972565802
Name:COOK, JASON WAVE (OD)
Entity Type:Individual
Prefix:
First Name:JASON
Middle Name:WAVE
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 1:600 LEIGHTON AVE
Mailing Address - Street 2:
Mailing Address - City:ANNISTON
Mailing Address - State:AL
Mailing Address - Zip Code:36207-5744
Mailing Address - Country:US
Mailing Address - Phone:256-238-8718
Mailing Address - Fax:256-238-8755
Practice Address - Street 1:600 LEIGHTON AVE
Practice Address - Street 2:
Practice Address - City:ANNISTON
Practice Address - State:AL
Practice Address - Zip Code:36207-5744
Practice Address - Country:US
Practice Address - Phone:256-238-8718
Practice Address - Fax:256-238-8755
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-05
Last Update Date:2023-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALS-932-TA-486152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
ALU79417Medicare UPIN