MEDICARE: DR. LISA MARIE COOK 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	2032	OK
2	152WV0400X	Vision Therapy Optometrist	2032	OK

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	410034238	OTHER		RAILROAD MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1942203203
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. LISA MARIE COOK O.D.

Provider Business Mailing Address
First Line	:	2114 W NOBLE AVE
Second Line	:
City	:	GUTHRIE
State	:	OK
Zip	:	73044-2116
Country	:	US
Telephone Number	:	405-260-2020
Fax Number	:	405-282-8886

Provider Business Practice Location Address
First Line	:	2114 W NOBLE AVE
Second Line	:
City	:	GUTHRIE
State	:	OK
Zip	:	73044-2116
Country	:	US
Telephone Number	:	405-260-2020
Fax Number	:	405-282-8886

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

Provider Enumeration Date	:	05/31/2005
Last Update Date	:	05/11/2010

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