Provider Demographics
NPI:1013070432
Name:COOK, ALAN DOUGLAS (OD)
Entity Type:Individual
Prefix:DR
First Name:ALAN
Middle Name:DOUGLAS
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 1:155 E MAIN ST
Mailing Address - Street 2:P.O. BOX 216
Mailing Address - City:FROSTBURG
Mailing Address - State:MD
Mailing Address - Zip Code:21532-1336
Mailing Address - Country:US
Mailing Address - Phone:301-689-1000
Mailing Address - Fax:
Practice Address - Street 1:155 E MAIN ST
Practice Address - Street 2:
Practice Address - City:FROSTBURG
Practice Address - State:MD
Practice Address - Zip Code:21532-1336
Practice Address - Country:US
Practice Address - Phone:301-689-1000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDTAO589152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDX123Medicare ID - Type UnspecifiedMEDICARE PART B
MD0862010001Medicare ID - Type UnspecifiedADMINISTAR