Provider Demographics
NPI:1366436701
Name:COOK, JEFFREY ALAN (OD)
Entity type:Individual
Prefix:DR
First Name:JEFFREY
Middle Name:ALAN
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 61
Mailing Address - Street 2:
Mailing Address - City:SIDNEY
Mailing Address - State:NE
Mailing Address - Zip Code:69162-0061
Mailing Address - Country:US
Mailing Address - Phone:308-254-4041
Mailing Address - Fax:308-254-3718
Practice Address - Street 1:900 PINE ST
Practice Address - Street 2:
Practice Address - City:SIDNEY
Practice Address - State:NE
Practice Address - Zip Code:69162-2241
Practice Address - Country:US
Practice Address - Phone:308-254-4041
Practice Address - Fax:308-254-3718
Is Sole Proprietor?:No
Enumeration Date:2005-08-31
Last Update Date:2020-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE892152WC0802X, 152WP0200X, 152WS0006X, 152WV0400X, 152WX0102X, 152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
No152WC0802XEye and Vision Services ProvidersOptometristCorneal and Contact Management
No152WP0200XEye and Vision Services ProvidersOptometristPediatrics
No152WS0006XEye and Vision Services ProvidersOptometristSports Vision
No152WV0400XEye and Vision Services ProvidersOptometristVision Therapy
No152WX0102XEye and Vision Services ProvidersOptometristOccupational Vision
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE245327OtherMIDLANDS CHOICE PROVIDER
NE37094OtherBCBS PROVIDER NUMBER
NE10025341000Medicaid
NE410025992OtherUNITED HEALTH CARE
NE5612210001Medicare NSC
NE245327OtherMIDLANDS CHOICE PROVIDER
NE279791Medicare PIN