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General NPI Number Information
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NPI Number | 1194908616
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Entity Type | Organization
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Legal Business Name | COOPER VISION CENTER, P.C.
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Dates
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Enumeration Date | 12/06/2007
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Last Update Date | 02/28/2008
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Provider Practice Location Address
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Address Line | 2414 RAINBOW DR
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City | GADSDEN
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State | AL
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Zip | 35901-5620
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Country | US
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Telephone | 256-413-7878
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Fax | 256-413-7874
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Provider Business Mailing Address
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Address Line | 2414 RAINBOW DR
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City | GADSDEN
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State | AL
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Zip | 35901-5620
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Country | US
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Telephone | 256-413-7878
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Fax | 256-413-7874
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Authorized Official
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Title or Position | OWNER
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Name | DR. JOHN MARK COOPER
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Credential | O.D.
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Telephone | 256-413-7878
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number | S-920-TA-487
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License Number State | AL
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