Provider Demographics
NPI:1396741450
Name:COOK, JOHN MICHAEL (OD)
Entity type:Individual
Prefix:
First Name:JOHN
Middle Name:MICHAEL
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 1:2111 HIGHLAND AVE
Mailing Address - Street 2:
Mailing Address - City:HUNTINGDON
Mailing Address - State:PA
Mailing Address - Zip Code:16652-9719
Mailing Address - Country:US
Mailing Address - Phone:814-643-5643
Mailing Address - Fax:814-641-2020
Practice Address - Street 1:828 WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:HUNTINGDON
Practice Address - State:PA
Practice Address - Zip Code:16652-1726
Practice Address - Country:US
Practice Address - Phone:814-643-2020
Practice Address - Fax:814-641-2020
Is Sole Proprietor?:No
Enumeration Date:2005-06-23
Last Update Date:2008-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOEG000641152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA289206Medicare ID - Type Unspecified
PA410046005Medicare PIN
PAU08099Medicare UPIN