Provider Demographics
NPI:1346498367
Name:COOPER, JARED LAWRENCE (OD)
Entity Type:Individual
Prefix:DR
First Name:JARED
Middle Name:LAWRENCE
Last Name:COOPER
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 1:547 W CHURCH ST
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:TN
Mailing Address - Zip Code:38351-1703
Mailing Address - Country:US
Mailing Address - Phone:801-674-9504
Mailing Address - Fax:
Practice Address - Street 1:547 W CHURCH ST
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:TN
Practice Address - Zip Code:38351-1703
Practice Address - Country:US
Practice Address - Phone:801-674-9504
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-09-03
Last Update Date:2024-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN3853152W00000X
IDODP-100596152W00000X
MDTA2968152W00000X
UT7347067-9934152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist