MEDICARE: DR. ANDREW G. COOK JR. OD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	152W00000X	Optometrist	1043	NC

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	410021048	OTHER	NC	RAILROAD MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	09176	OTHER	NC	BCBS, STATE, NC HEALTHCH
3	246395B	OTHER	NC	PALMETTO
4	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
5	2255655	OTHER	NC	UHC
6	4458483	OTHER	NC	AETNA

General Provider Information

NPI Number	:	1063413607
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ANDREW G. COOK JR. OD

Provider Business Mailing Address
First Line	:	1003 VANDORA SPRINGS RD
Second Line	:
City	:	GARNER
State	:	NC
Zip	:	27529-3545
Country	:	US
Telephone Number	:	919-772-4575
Fax Number	:

Provider Business Practice Location Address
First Line	:	1003 VANDORA SPRINGS RD
Second Line	:
City	:	GARNER
State	:	NC
Zip	:	27529-3545
Country	:	US
Telephone Number	:	919-772-4575
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/04/2005
Last Update Date	:	11/14/2017

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