Healthcare Provider Details

I. General information

NPI: 1497903363
Provider Name (Legal Business Name): ARTHUR M. COPELAND OD AND JUDITH GUEST COPELAND OD PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/04/2008
Last Update Date: 01/20/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

204 S RIDGE ST
RYE BROOK NY
10573-3434
US

IV. Provider business mailing address

204 S RIDGE ST
RYE BROOK NY
10573-3434
US

V. Phone/Fax

Practice location:
  • Phone: 914-939-0830
  • Fax: 914-939-7029
Mailing address:
  • Phone: 914-939-0830
  • Fax: 914-939-7029

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code332H00000X
TaxonomyEyewear Supplier
License Number
License Number StateNY

VIII. Authorized Official

Name: DR. ARTHUR M COPELAND
Title or Position: PRESIDENT
Credential: O.D.
Phone: 914-939-0830