Provider Demographics
NPI:1083608608
Name:COPPES, JEFFREY A (OD)
Entity Type:Individual
Prefix:DR
First Name:JEFFREY
Middle Name:A
Last Name:COPPES
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6502 GRAPE ROAD
Mailing Address - Street 2:SUITE 898
Mailing Address - City:MISHAWAKA
Mailing Address - State:IN
Mailing Address - Zip Code:46545
Mailing Address - Country:US
Mailing Address - Phone:574-277-7723
Mailing Address - Fax:574-277-9698
Practice Address - Street 1:6502 GRAPE ROAD
Practice Address - Street 2:SUITE 898
Practice Address - City:MISHAWAKA
Practice Address - State:IN
Practice Address - Zip Code:46545
Practice Address - Country:US
Practice Address - Phone:574-277-7723
Practice Address - Fax:574-277-9698
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-09
Last Update Date:2013-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN18002135A152W00000X
IN18002135B152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
ININ2135OtherEYE MED ELKHART
ININ72135OtherVISIONBENEFITSAMERICA ELK
IN000000273033OtherBLUE CROSS ELKHART
IN01172OtherSPECTERA ELKHART
ININ2135OtherEYEMED
IN100414710Medicaid
IN2550910002OtherDMERC ELKHART
IN351368448OtherVISION SERVICE PLAN
IN01172OtherSPECTERA ELKHART
IN351368448OtherVISION SERVICE PLAN
IN100414710Medicaid
IN194030BMedicare PIN