MEDICARE: DR. RUBY YOUNG COOPER OD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	152W00000X	Optometrist	TA1345	MD

General Provider Information

NPI Number	:	1336221316
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. RUBY YOUNG COOPER OD

Provider Business Mailing Address
First Line	:	7515 BURGESS LANDE
Second Line	:
City	:	FT. WASHINGTON
State	:	MD
Zip	:	20744
Country	:	US
Telephone Number	:	301-736-5600
Fax Number	:

Provider Business Practice Location Address
First Line	:	7515 BURGESS LN
Second Line	:
City	:	FT WASHINGTON
State	:	MD
Zip	:	20744-1710
Country	:	US
Telephone Number	:	301-248-6191
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/19/2006
Last Update Date	:	07/08/2007

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