Provider Demographics
NPI:1336334648
Name:JAMES WESLEY COOK, M.D., LTD
Entity Type:Organization
Organization Name:JAMES WESLEY COOK, M.D., LTD
Other - Org Name:COOK EYE CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:WESLEY
Authorized Official - Last Name:COOK
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:601-638-2081
Mailing Address - Street 1:1206 MISSION 66
Mailing Address - Street 2:
Mailing Address - City:VICKSBURG
Mailing Address - State:MS
Mailing Address - Zip Code:39183-3137
Mailing Address - Country:US
Mailing Address - Phone:601-638-2081
Mailing Address - Fax:601-638-2171
Practice Address - Street 1:1206 MISSION 66
Practice Address - Street 2:
Practice Address - City:VICKSBURG
Practice Address - State:MS
Practice Address - Zip Code:39183-3137
Practice Address - Country:US
Practice Address - Phone:601-638-2081
Practice Address - Fax:601-638-2171
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-10
Last Update Date:2007-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS08930174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MSC00901Medicare PIN