MEDICARE: DR. ALAN BEN COOPERMAN O.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	152W00000X	Optometrist	6190T	CA

General Provider Information

NPI Number	:	1538290002
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ALAN BEN COOPERMAN O.D.

Provider Business Mailing Address
First Line	:	18 SURF WATER CT
Second Line	:
City	:	SACRAMENTO
State	:	CA
Zip	:	95831-5583
Country	:	US
Telephone Number	:	916-281-8712
Fax Number	:

Provider Business Practice Location Address
First Line	:	3661 TRUXEL RD
Second Line	:
City	:	SACRAMENTO
State	:	CA
Zip	:	95834-3604
Country	:	US
Telephone Number	:	916-928-6097
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/08/2007
Last Update Date	:	07/08/2007

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