MEDICARE: THERESA MARLENE COPPOLINO-LANDINO OPHTHALMIC DISPENSER

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	156FX1800X	Optician	31TD00328100	NJ

General Provider Information

NPI Number	:	1982550869
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	THERESA MARLENE COPPOLINO-LANDINO OPHTHALMIC DISPENSER

Provider Business Mailing Address
First Line	:	11 FREDON MARKSBORO RD
Second Line	:
City	:	NEWTON
State	:	NJ
Zip	:	07860-5013
Country	:	US
Telephone Number	:	973-216-5188
Fax Number	:

Provider Business Practice Location Address
First Line	:	11 FREDON MARKSBORO RD
Second Line	:
City	:	NEWTON
State	:	NJ
Zip	:	07860-5013
Country	:	US
Telephone Number	:	973-216-5188
Fax Number	:

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

Provider Enumeration Date	:	03/04/2026
Last Update Date	:	03/04/2026

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