Individual
GLENN COOK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
7877 PARKWAY DR, SUITE 100, LA MESA, CA 91942-2000
(619) 460-3711
(619) 460-2184
Mailing address
7877 PARKWAY DR, SUITE 100, LA MESA, CA 91942-2000
(619) 460-3711
(619) 460-2184
Taxonomy
Speciality
Code
Description
License number
State
207W00000X
Ophthalmology Physician
Primary
G63727
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00G637271
—
CA
01
—
0802380001
NORIDIAN PROVIDER NUMBER
CA
01
—
0802380003
CORONADO OFFICE NORIDIAN
CA
Enumeration date
12/12/2006
Last updated
01/19/2011
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