Healthcare Provider Details

I. General information

NPI: 1710220330
Provider Name (Legal Business Name): THOMAS COPPERMAN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/02/2013
Last Update Date: 06/03/2020
Certification Date: 06/03/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1101 MADISON ST STE 600
SEATTLE WA
98104-1340
US

IV. Provider business mailing address

1101 MADISON ST STE 600
SEATTLE WA
98104-1340
US

V. Phone/Fax

Practice location:
  • Phone: 206-215-2020
  • Fax: 206-215-2022
Mailing address:
  • Phone: 206-215-2020
  • Fax: 206-215-2022

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License NumberMD61042379
License Number StateWA
# 2
Primary TaxonomyN
Taxonomy Code207WX0200X
TaxonomyOphthalmic Plastic and Reconstructive Surgery Physician
License NumberMD61043249
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: