Healthcare Provider Details

I. General information

NPI: 1851811913
Provider Name (Legal Business Name): JAMES L COOPERMAN OD INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/20/2017
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18449 BROOKHURST ST STE 6
FOUNTAIN VALLEY CA
92708-6751
US

IV. Provider business mailing address

18449 BROOKHURST ST STE 6
FOUNTAIN VALLEY CA
92708-6751
US

V. Phone/Fax

Practice location:
  • Phone: 714-963-2111
  • Fax: 714-963-4642
Mailing address:
  • Phone: 714-963-2111
  • Fax: 714-963-4642

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code152WC0802X
TaxonomyCorneal and Contact Management Optometrist
License Number
License Number State

VIII. Authorized Official

Name: JAMES L COOPERMAN
Title or Position: OWNER
Credential: O.D.
Phone: 714-963-2111