Provider Demographics
NPI:1194714733
Name:COOK, JONATHAN F (OD)
Entity type:Individual
Prefix:DR
First Name:JONATHAN
Middle Name:F
Last Name:COOK
Suffix:
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:PO BOX 1088
Mailing Address - Street 2:
Mailing Address - City:GRAY
Mailing Address - State:ME
Mailing Address - Zip Code:04039-1088
Mailing Address - Country:US
Mailing Address - Phone:207-657-4488
Mailing Address - Fax:207-657-4574
Practice Address - Street 1:6 TURNPIKE ACRES ROAD
Practice Address - Street 2:
Practice Address - City:GRAY
Practice Address - State:ME
Practice Address - Zip Code:04039
Practice Address - Country:US
Practice Address - Phone:207-657-4488
Practice Address - Fax:207-657-4574
Is Sole Proprietor?:No
Enumeration Date:2005-10-17
Last Update Date:2009-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEOPT855152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MEMM9663OtherMEDICARE GROUP #
ME291370099Medicaid
ME134208862OtherGROUP TAX ID#
ME100225OtherANTHEM
ME1821106105OtherGROUP NPI
ME100225OtherANTHEM
ME291370099Medicaid
ME1821106105OtherGROUP NPI