Provider Demographics
NPI:1295156800
Name:COOKE VISION, PLLC
Entity type:Organization
Organization Name:COOKE VISION, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPTOMETRIST
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:KENNETH
Authorized Official - Last Name:COOKE
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:254-338-4305
Mailing Address - Street 1:4104 E STAN SCHLUETER LOOP STE 6
Mailing Address - Street 2:
Mailing Address - City:KILLEEN
Mailing Address - State:TX
Mailing Address - Zip Code:76542-7873
Mailing Address - Country:US
Mailing Address - Phone:254-690-8999
Mailing Address - Fax:866-752-0649
Practice Address - Street 1:4104 E STAN SCHLUETER LOOP STE 6
Practice Address - Street 2:
Practice Address - City:KILLEEN
Practice Address - State:TX
Practice Address - Zip Code:76542-7873
Practice Address - Country:US
Practice Address - Phone:254-690-8999
Practice Address - Fax:866-752-0649
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-12-27
Last Update Date:2013-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX5561T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0191389-01Medicaid
TX1972510329OtherINDIVIDUAL NPI