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General NPI Number Information
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NPI Number | 1992912695
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Entity Type | Individual
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Provider Name | RUSSELL YALE COOKE III OD DOCTOR OF OPTOMET
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Gender | Male
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Dates
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Enumeration Date | 05/16/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 100 PLUMOSA STREET EYEGLASS WORLD
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City | MERRITT ISLAND
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State | FL
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Zip | 32952
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Country | US
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Telephone | 321-455-2950
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Fax | 321-455-9719
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Provider Business Mailing Address
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Address Line | 2401 CARRIAGE COURT
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City | INDIALANTIC
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State | FL
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Zip | 32903-2448
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Country | US
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Telephone | 321-777-4400
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Fax | 321-777-4400
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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 | OPC001729
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License Number State | FL
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