Lyman D Cook, O.D.
Individual provider Active NPI Optometrist · Springfield, MO
NPI 1477593564 · NPPES record last updated Jul 9, 2007
Key facts
- NPI
- 1477593564
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Optometrist 152W00000X
- License
- T02432 (MO)
- Practice address
- 1724 W Kearney St
Suite 116
Springfield, MO 65803-1645 - Phone
- (417) 865-4448
- Fax
- (417) 862-8704
- NPI assigned
- Jun 7, 2006
- Sex
- Male
- Sole proprietor
- Yes
Organizations & group practices 2
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in MO
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: No · Hospice: Yes
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20040923000004 | MO | Practitioner - Optometry | 2961470323 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| T02432 | MO | MD | Optometrist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Advanced Family Eye Care Inc | Optometrist | Current |
Accepting new patients |
| Springfield Eyecare, LLC | Optometrist | Past | Accepting new patients |
Locations
1724 W Kearney St
Ste 116
Springfield, MO 65803
Phone (417) 865-4448
1724 W Kearney St
Springfield, MO 65803
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Optometrist | 152W00000X | T02432 | MO | Yes |
Addresses
Primary practice location
1724 W Kearney St
Suite 116
Springfield, MO 65803-1645
Mailing address
1724 W Kearney St
Suite 116
Springfield, MO 65803-1645
Phone (417) 865-4448
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 157403 | Other | MO | BLUE CROSS BLUE SHIELD |
| 43141947565803A002 | Other | MO | TRI WEST |
| AF26850 | Other | MO | SPECTERA |
| MO2432 | Other | MO | EYEMED VISION CARE |
| 4178654448 | Other | MO | VISION SERVICE PLAN |
Other providers in Springfield, MO
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 9, 2007. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.