Provider Demographics
NPI:1154402493
Name:COOKE LANDEN & GRUTZMACHER OD INC
Entity type:Organization
Organization Name:COOKE LANDEN & GRUTZMACHER OD INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:SECRETARY
Authorized Official - Prefix:DR
Authorized Official - First Name:DONALD
Authorized Official - Middle Name:R
Authorized Official - Last Name:GRUTZMACHER
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:513-753-8225
Mailing Address - Street 1:486 OHIO PIKE
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45255-3343
Mailing Address - Country:US
Mailing Address - Phone:513-753-8225
Mailing Address - Fax:513-753-8589
Practice Address - Street 1:486 OHIO PIKE
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45255-3343
Practice Address - Country:US
Practice Address - Phone:513-753-8225
Practice Address - Fax:513-753-8589
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-17
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH=========Medicare UPINOPTOMETRIST
OH0443280002Medicare NSC
OH=========Medicare UPIN