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General NPI Number Information
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NPI Number | 1538145057
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Entity Type | Individual
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Provider Name | STEPHEN COOLEY O.D.
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Gender | Male
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Dates
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Enumeration Date | 12/16/2005
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Last Update Date | 06/16/2014
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Provider Practice Location Address
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Address Line | 2901 174TH ST NE
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City | MARYSVILLE
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State | WA
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Zip | 98271-4743
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Country | US
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Telephone | 360-454-1936
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Fax | 360-454-1991
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Provider Business Mailing Address
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Address Line | PO BOX 5127
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City | EVERETT
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State | WA
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Zip | 98206-5127
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Country | US
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Telephone | 425-259-0966
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Fax | 425-258-3910
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number | 1210
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License Number State | CO
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Taxonomy #2
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number | OD60288309
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License Number State | WA
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