Organization
ALTERNATIVE VISION SERVICES
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. MARK F COOK O.D. (PROPRIETER)
(920) 390-9038
Entity
Organization
Contact information
Practice address
1612 COMMONWEALTH DR, #4, FORT ATKINSON, WI 53538-3147
(920) 397-7094
Mailing address
1612 COMMONWEALTH DR, #4, FORT ATKINSON, WI 53538-3147
(920) 397-7094
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
2358-035
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
38724000
—
WI
Enumeration date
09/25/2008
Last updated
09/25/2008
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