Provider Demographics
NPI:1275579567
Name:COOPER, BLAKE A (MD)
Entity Type:Individual
Prefix:DR
First Name:BLAKE
Middle Name:A
Last Name:COOPER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:8600 QUIVIRA RD STE 100
Mailing Address - Street 2:
Mailing Address - City:LENEXA
Mailing Address - State:KS
Mailing Address - Zip Code:66215-2857
Mailing Address - Country:US
Mailing Address - Phone:913-831-7400
Mailing Address - Fax:913-831-7409
Practice Address - Street 1:8600 QUIVIRA RD STE 100
Practice Address - Street 2:
Practice Address - City:LENEXA
Practice Address - State:KS
Practice Address - Zip Code:66215-2857
Practice Address - Country:US
Practice Address - Phone:913-831-7400
Practice Address - Fax:913-831-7409
Is Sole Proprietor?:No
Enumeration Date:2006-06-22
Last Update Date:2022-08-26
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MO2001014975174400000X, 207W00000X, 207WX0107X
KS0430052207WX0107X, 207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
No174400000XOther Service ProvidersSpecialist
No207WX0107XAllopathic & Osteopathic PhysiciansOphthalmologyRetina Specialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO205348923Medicaid
KSP00303366OtherRAILROAD MEDICARE
KS102970OtherBLUE CROSS BLUE SHIELD OF
MO32456016OtherBLUE CROSS BLUE SHIELD OF
MOP00024558OtherRAILROAD MEDICARE
MOMA3835003Medicare PIN
MOK42C470Medicare PIN
MOP00024558OtherRAILROAD MEDICARE
MO32456016OtherBLUE CROSS BLUE SHIELD OF