Healthcare Provider Details

I. General information

NPI: 1477679488
Provider Name (Legal Business Name): DAVID L. COOK O.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/21/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1395 S MARIETTA PKWY SE BLD. 400, STE. 116
MARIETTA GA
30067-4440
US

IV. Provider business mailing address

1395 S MARIETTA PKWY SE BLD. 400, STE. 116
MARIETTA GA
30067-4440
US

V. Phone/Fax

Practice location:
  • Phone: 770-419-0400
  • Fax:
Mailing address:
  • Phone: 770-419-0400
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152WV0400X
TaxonomyVision Therapy Optometrist
License Number000932
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: