MEDICARE: COOPERATIVE OPTICAL SERVICES, 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	332B00000X	Durable Medical Equipment & Medical Supplies

General Provider Information

NPI Number	:	1992859748
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	COOPERATIVE OPTICAL SERVICES, INC.

Provider Business Mailing Address
First Line	:	2424 E 8 MILE RD
Second Line	:
City	:	DETROIT
State	:	MI
Zip	:	48234-1010
Country	:	US
Telephone Number	:	313-366-5100
Fax Number	:	313-366-2246

Provider Business Practice Location Address
First Line	:	31225 ORCHARD LAKE RD
Second Line	:
City	:	FARMINGTON HILLS
State	:	MI
Zip	:	48334-1344
Country	:	US
Telephone Number	:	248-737-1880
Fax Number	:	248-737-1886

Authorized Official
Title or Position	:	MANAGE CARE MANAGER
Name	:	MRS. CHRISTELL JONES
Credential	:
Telephone Number	:	313-366-5100

Provider Enumeration Date	:	01/22/2007
Last Update Date	:	06/20/2018

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