Provider Demographics
NPI:1164523874
Name:IACOPONI, LOUIS R (OD)
Entity Type:Individual
Prefix:DR
First Name:LOUIS
Middle Name:R
Last Name:IACOPONI
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 1:1301B N KINGS HWY
Mailing Address - Street 2:
Mailing Address - City:CHERRY HILL
Mailing Address - State:NJ
Mailing Address - Zip Code:08034-1918
Mailing Address - Country:US
Mailing Address - Phone:856-795-5656
Mailing Address - Fax:
Practice Address - Street 1:1301B N KINGS HWY
Practice Address - Street 2:
Practice Address - City:CHERRY HILL
Practice Address - State:NJ
Practice Address - Zip Code:08034-1918
Practice Address - Country:US
Practice Address - Phone:856-795-5656
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-26
Last Update Date:2009-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ270A00467400152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ2435705Medicaid
NJ483486Medicare PIN
NJT30667Medicare UPIN