Healthcare Provider Details

I. General information

NPI: 1124881057
Provider Name (Legal Business Name): JEFFREY COOPER O.D., P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/02/2024
Last Update Date: 02/02/2024
Certification Date: 02/02/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1038 SOUTHERN BLVD
BRONX NY
10459-3407
US

IV. Provider business mailing address

1448 86TH ST
BROOKLYN NY
11228-3444
US

V. Phone/Fax

Practice location:
  • Phone: 718-328-7137
  • Fax: 347-758-6396
Mailing address:
  • Phone: 718-265-2020
  • Fax: 718-837-0431

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number
License Number State

VIII. Authorized Official

Name: JEFFREY COOPER
Title or Position: OD
Credential:
Phone: 718-236-4186