Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 152W00000X | Optometrist | 892 | NE |
N | 152WC0802X | Optomitrist - Corneal and Contact Lenses | 892 | NE |
N | 152WP0200X | Pediatric Optomitrist | 892 | NE |
N | 152WS0006X | Sports Vision | 892 | NE |
N | 152WV0400X | Optomitrist - Vision Therapist | 892 | NE |
N | 152WX0102X | Occupational Vision | 892 | NE |
NPI | 1366436701 |
---|---|
Provider Name | Dr. Jeffrey Alan Cook |
First Address | Sidney, NE 69162-0061 |
Second Address | Sidney, NE 69162-2241 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 31/08/2005 |
Last Update Date | 19/02/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
10025341000 | (05) | NE |
245327 | MIDLANDS CHOICE PROVIDER (01) | NE |
37094 | BCBS PROVIDER NUMBER (01) | NE |
410025992 | UNITED HEALTH CARE (01) | NE |
T40300 | (02) | NE |