Provider Demographics
NPI:1093797300
Name:COPPOLA, JAMES B (OD)
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:B
Last Name:COPPOLA
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:19100 MURDOCK CIR
Mailing Address - Street 2:
Mailing Address - City:PORT CHARLOTTE
Mailing Address - State:FL
Mailing Address - Zip Code:33948-1022
Mailing Address - Country:US
Mailing Address - Phone:941-625-7437
Mailing Address - Fax:941-625-2731
Practice Address - Street 1:19100 MURDOCK CIR
Practice Address - Street 2:
Practice Address - City:PORT CHARLOTTE
Practice Address - State:FL
Practice Address - Zip Code:33948-1022
Practice Address - Country:US
Practice Address - Phone:941-625-7437
Practice Address - Fax:941-625-2731
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOPC2816152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLU52968Medicare UPIN
FL20544Medicare ID - Type Unspecified