1477593564 NPI number — DR. LYMAN D COOK O.D.

Table of content: DR. LYMAN D COOK O.D. (NPI 1477593564)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1477593564 NPI number — DR. LYMAN D COOK O.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
COOK
Provider First Name:
LYMAN
Provider Middle Name:
D
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
O.D.
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1477593564
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/09/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1724 W KEARNEY ST
Provider Second Line Business Mailing Address:
SUITE 116
Provider Business Mailing Address City Name:
SPRINGFIELD
Provider Business Mailing Address State Name:
MO
Provider Business Mailing Address Postal Code:
65803-1645
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
417-865-4448
Provider Business Mailing Address Fax Number:
417-862-8704

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1724 W KEARNEY ST
Provider Second Line Business Practice Location Address:
SUITE 116
Provider Business Practice Location Address City Name:
SPRINGFIELD
Provider Business Practice Location Address State Name:
MO
Provider Business Practice Location Address Postal Code:
65803-1645
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
417-865-4448
Provider Business Practice Location Address Fax Number:
417-862-8704
Provider Enumeration Date:
06/07/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 152W00000X , with the licence number:  T02432 , registered in the state of MO ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 157403 . This is a "BLUE CROSS BLUE SHIELD" identifier , issued by the state of ( MO ) . This identifiers is of the category "OTHER".
  • Identifier: 43141947565803A002 . This is a "TRI WEST" identifier , issued by the state of ( MO ) . This identifiers is of the category "OTHER".
  • Identifier: AF26850 . This is a "SPECTERA" identifier , issued by the state of ( MO ) . This identifiers is of the category "OTHER".
  • Identifier: MO2432 . This is a "EYEMED VISION CARE" identifier , issued by the state of ( MO ) . This identifiers is of the category "OTHER".
  • Identifier: 4178654448 . This is a "VISION SERVICE PLAN" identifier , issued by the state of ( MO ) . This identifiers is of the category "OTHER".




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