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General NPI Number Information
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NPI Number | 1497050991
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Entity Type | Individual
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Provider Name | ELIZABETH COPPOLA OPTICIAN
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Gender | Female
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Dates
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Enumeration Date | 01/14/2011
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Last Update Date | 02/14/2011
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Provider Practice Location Address
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Address Line | 111 RETREAT ST
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City | WESTMINSTER
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State | SC
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Zip | 29693-1724
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Country | US
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Telephone | 864-647-5076
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Fax | 864-647-0828
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Provider Business Mailing Address
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Address Line | 111 RETREAT ST
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City | WESTMINSTER
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State | SC
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Zip | 29693-1724
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Country | US
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Telephone | 864-647-5076
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Fax | 864-647-0828
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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 | 156FX1800X
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Taxonomy Name | Optician
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License Number | 165252
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License Number State | SC
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