Provider Demographics
NPI:1265500110
Name:COOK, GREGORY S (OD INC)
Entity type:Individual
Prefix:
First Name:GREGORY
Middle Name:S
Last Name:COOK
Suffix:
Gender:M
Credentials:OD INC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1621 TEXAS ST
Mailing Address - Street 2:
Mailing Address - City:WOODWARD
Mailing Address - State:OK
Mailing Address - Zip Code:73801-3041
Mailing Address - Country:US
Mailing Address - Phone:580-256-1288
Mailing Address - Fax:580-256-7571
Practice Address - Street 1:1621 TEXAS ST
Practice Address - Street 2:
Practice Address - City:WOODWARD
Practice Address - State:OK
Practice Address - Zip Code:73801-3041
Practice Address - Country:US
Practice Address - Phone:580-256-1288
Practice Address - Fax:580-256-7571
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-30
Last Update Date:2008-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK1130152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK100760090AMedicaid
OKT-404002Medicare UPIN
OK$$$$$$$$$Medicare PIN
OK100760090AMedicaid