Healthcare Provider Details

I. General information

NPI: 1972122687
Provider Name (Legal Business Name): COOPER RODGERS MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/13/2020
Last Update Date: 01/22/2025
Certification Date: 01/22/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

21020 W 151ST ST
OLATHE KS
66061-7200
US

IV. Provider business mailing address

21020 W 151ST ST
OLATHE KS
66061-7200
US

V. Phone/Fax

Practice location:
  • Phone: 913-829-5511
  • Fax: 913-829-5571
Mailing address:
  • Phone: 913-829-5511
  • Fax: 913-829-5571

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number2024038020
License Number StateMO
# 2
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number04-49887
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: