MEDICARE: DR. INGRID S WHITBOURNE-COOKE O.D.

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	3064	FL

General Provider Information

NPI Number	:	1174528632
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. INGRID S WHITBOURNE-COOKE O.D.

Provider Business Mailing Address
First Line	:	8252 NW 15TH CT
Second Line	:
City	:	CORAL SPRINGS
State	:	FL
Zip	:	33071-6211
Country	:	US
Telephone Number	:	954-706-2037
Fax Number	:

Provider Business Practice Location Address
First Line	:	3001 N STATE ROAD 7
Second Line	:
City	:	LAUDERDALE LAKES
State	:	FL
Zip	:	33313-1913
Country	:	US
Telephone Number	:	954-733-2066
Fax Number	:

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

Provider Enumeration Date	:	06/20/2005
Last Update Date	:	11/25/2017

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