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NPI Code Detail

MEDICARE: ALAN LEE COPELAND O.D.

MEDICARE: ALAN LEE COPELAND 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
1152W00000XOptometristOD00003959WA

General Provider Information

NPI Number : 1720192768
Entity Type Code : Individual
Provider Name (Legal Business Name) : ALAN LEE COPELAND O.D.
Provider Business Mailing Address
First Line : 302 BILLY SMITH RD
Second Line :
City : PORT ANGELES
State : WA
Zip : 98362-9314
Country : US
Telephone Number : 360-681-8561
Fax Number :
Provider Business Practice Location Address
First Line : 1110 W WASHINGTON ST
Second Line :
City : SEQUIM
State : WA
Zip : 98382-3270
Country : US
Telephone Number : 360-683-1590
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/18/2006
Last Update Date : 01/03/2019

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