MEDICARE: MEGAN COOK

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	156FX1800X	Optician	266611	KY

General Provider Information

NPI Number	:	1730813056
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MEGAN COOK

Provider Business Mailing Address
First Line	:	3450 VALLEY PLAZA PKWY
Second Line	:
City	:	FT MITCHELL
State	:	KY
Zip	:	41017-8177
Country	:	US
Telephone Number	:	859-341-3767
Fax Number	:	859-341-3789

Provider Business Practice Location Address
First Line	:	3450 VALLEY PLAZA PKWY
Second Line	:
City	:	FT MITCHELL
State	:	KY
Zip	:	41017-8177
Country	:	US
Telephone Number	:	859-341-3767
Fax Number	:	859-341-3789

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/12/2022
Last Update Date	:	07/12/2022

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Directions to “ MEGAN COOK ” Practice Location

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