MEDICARE: COPE OPTOMETRICS, INC

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		IL

General Provider Information

NPI Number	:	1497942213
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	COPE OPTOMETRICS, INC

Provider Business Mailing Address
First Line	:	14702 CICERO AVE
Second Line	:
City	:	MIDLOTHIAN
State	:	IL
Zip	:	60445-3173
Country	:	US
Telephone Number	:	708-687-2115
Fax Number	:	708-687-6537

Provider Business Practice Location Address
First Line	:	14702 CICERO AVE
Second Line	:
City	:	MIDLOTHIAN
State	:	IL
Zip	:	60445-3173
Country	:	US
Telephone Number	:	708-687-2115
Fax Number	:	708-687-6537

Authorized Official
Title or Position	:	OPTMETRIST/OWNER
Name	:	DR. RONALD H. COPE
Credential	:	O.D.
Telephone Number	:	708-687-2115

Provider Enumeration Date	:	09/25/2007
Last Update Date	:	04/14/2008

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