Provider Demographics
NPI:1073657383
Name:COOPER, SHEILA CASSIOLI (OD)
Entity Type:Individual
Prefix:DR
First Name:SHEILA
Middle Name:CASSIOLI
Last Name:COOPER
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2306 MARKET ST
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:28403-1134
Mailing Address - Country:US
Mailing Address - Phone:910-251-8904
Mailing Address - Fax:
Practice Address - Street 1:3500 OLEANDER DR
Practice Address - Street 2:SUITE B-10
Practice Address - City:WILMINGTON
Practice Address - State:NC
Practice Address - Zip Code:28403-0811
Practice Address - Country:US
Practice Address - Phone:910-452-3290
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC1281152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC890919CMedicaid
NC2468271HMedicare ID - Type Unspecified