Healthcare Provider Details

I. General information

NPI: 1093395147
Provider Name (Legal Business Name): KAYLA NICOLE COOK OD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/13/2021
Last Update Date: 06/04/2022
Certification Date: 06/04/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2114 W NOBLE AVE
GUTHRIE OK
73044
US

IV. Provider business mailing address

2114 W NOBLE AVE
GUTHRIE OK
73044-2116
US

V. Phone/Fax

Practice location:
  • Phone: 405-260-2020
  • Fax:
Mailing address:
  • Phone: 405-260-2020
  • Fax: 405-282-8886

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number10362T
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number3119
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: