Provider Demographics
NPI:1063413607
Name:COOK, ANDREW G JR (OD)
Entity type:Individual
Prefix:DR
First Name:ANDREW
Middle Name:G
Last Name:COOK
Suffix:JR
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1003 VANDORA SPRINGS RD
Mailing Address - Street 2:
Mailing Address - City:GARNER
Mailing Address - State:NC
Mailing Address - Zip Code:27529-3545
Mailing Address - Country:US
Mailing Address - Phone:919-772-4575
Mailing Address - Fax:
Practice Address - Street 1:1003 VANDORA SPRINGS RD
Practice Address - Street 2:
Practice Address - City:GARNER
Practice Address - State:NC
Practice Address - Zip Code:27529-3545
Practice Address - Country:US
Practice Address - Phone:919-772-4575
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-04
Last Update Date:2017-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC1043152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC410021048OtherRAILROAD MEDICARE
NC09176OtherBCBS, STATE, NC HEALTHCH
NC246395BOtherPALMETTO
NC8909176Medicaid
NC2255655OtherUHC
NC4458483OtherAETNA
NC8909176Medicaid
NC246395BMedicare ID - Type Unspecified