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General NPI Number Information
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NPI Number | 1215901038
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Entity Type | Individual
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Provider Name | MARTIN R COPELAND OD
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Gender | Male
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Dates
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Enumeration Date | 02/16/2006
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Last Update Date | 01/10/2017
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Provider Practice Location Address
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Address Line | 101 SOUTH BERGEN PLACE
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City | FREEPORT
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State | NY
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Zip | 11120
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Country | US
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Telephone | 516-623-3600
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Fax | 516-623-9191
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Provider Business Mailing Address
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Address Line | 1451 CORAL RIDGE AVE STE 518
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City | CORALVILLE
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State | IA
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Zip | 52241-2805
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Country | US
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Telephone | 917-532-9114
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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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 | TUV006680
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License Number State | NY
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