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General NPI Number Information
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NPI Number | 1922537463
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Entity Type | Individual
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Provider Name | MARISSA CRISTINA KOOPMAN OD
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Gender | Female
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Dates
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Enumeration Date | 06/08/2017
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Last Update Date | 06/26/2017
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Provider Practice Location Address
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Address Line | 79 MIDDLEVILLE RD
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City | NORTHPORT
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State | NY
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Zip | 11768-2200
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Country | US
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Telephone | 631-261-4400
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Fax |
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Provider Business Mailing Address
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Address Line | 10 SANDPIPER LN
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City | EAST ISLIP
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State | NY
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Zip | 11730-3115
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Country | US
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Telephone | 631-871-5552
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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 | 008625
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License Number State | NY
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