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General NPI Number Information
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NPI Number | 1669522553
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Entity Type | Individual
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Provider Name | MICHAEL D COOK O.D.
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Gender | Male
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Dates
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Enumeration Date | 01/11/2007
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Last Update Date | 08/30/2010
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Provider Practice Location Address
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Address Line | 265 LAGUNA AVE
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City | LAGUNA BEACH
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State | CA
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Zip | 92651-2119
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Country | US
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Telephone | 949-494-1892
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Fax |
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Provider Business Mailing Address
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Address Line | 14 ALERIA
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City | LAGUNA NIGUEL
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State | CA
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Zip | 92677-8620
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Country | US
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Telephone | 949-249-2655
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Fax | 949-250-1415
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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 | 9227T
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License Number State | CA
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