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General NPI Number Information
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NPI Number | 1629013040
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Entity Type | Organization
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Legal Business Name | DR TED S COOPER OPTOMETRY LLC
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Dates
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Enumeration Date | 06/19/2006
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Last Update Date | 01/02/2008
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Provider Practice Location Address
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Address Line | 2028 W POPLAR AVE SUITE 102
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City | COLLIERVILLE
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State | TN
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Zip | 38017-0618
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Country | US
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Telephone | 901-850-7900
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Fax | 901-850-7997
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Provider Business Mailing Address
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Address Line | 2028 W POPLAR AVE SUITE 102
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City | COLLIERVILLE
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State | TN
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Zip | 38017-0618
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Country | US
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Telephone | 901-850-7900
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Fax | 901-850-7997
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Authorized Official
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Title or Position | CHIEF MANAGER
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Name | DR. THEODORE S. COOPER
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Credential | O.D.
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Telephone | 901-850-7900
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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 | T2319
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License Number State | TN
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