MEDICARE: ANDREW DAVID COOPER

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	AT4824	OR

General Provider Information

NPI Number	:	1992635262
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ANDREW DAVID COOPER

Provider Business Mailing Address
First Line	:	5379 NW LIANNA WAY
Second Line	:
City	:	PORTLAND
State	:	OR
Zip	:	97229-8971
Country	:	US
Telephone Number	:	503-548-7512
Fax Number	:

Provider Business Practice Location Address
First Line	:	8700 NE VANCOUVER MALL DR
Second Line	:
City	:	VANCOUVER
State	:	WA
Zip	:	98662-6750
Country	:	US
Telephone Number	:	360-253-3663
Fax Number	:

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

Provider Enumeration Date	:	05/20/2026
Last Update Date	:	06/13/2026

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