Healthcare Provider Details

I. General information

NPI: 1376899237
Provider Name (Legal Business Name): ALYSSA ANNE MILLIGAN COOPER O.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/30/2012
Last Update Date: 04/29/2025
Certification Date: 04/29/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2401 KENTUCKY AVE STE A
PLATTE CITY MO
64079-7639
US

IV. Provider business mailing address

11261 NALL AVE SUITE 192
LEAWOOD KS
66211-1669
US

V. Phone/Fax

Practice location:
  • Phone: 816-431-2202
  • Fax: 816-431-2202
Mailing address:
  • Phone: 913-261-2020
  • Fax: 913-671-3225

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number2016002504
License Number StateMO
# 2
Primary TaxonomyN
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number1922
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: