Provider Demographics
NPI:1356464978
Name:COOPER, CAROL LYNN (MD, PHD,)
Entity Type:Individual
Prefix:DR
First Name:CAROL
Middle Name:LYNN
Last Name:COOPER
Suffix:
Gender:F
Credentials:MD, PHD,
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3300 APPLEWOOD RD
Mailing Address - Street 2:
Mailing Address - City:MIDLAND
Mailing Address - State:MI
Mailing Address - Zip Code:48640-2669
Mailing Address - Country:US
Mailing Address - Phone:989-832-0042
Mailing Address - Fax:989-832-0042
Practice Address - Street 1:3300 APPLEWOOD RD
Practice Address - Street 2:
Practice Address - City:MIDLAND
Practice Address - State:MI
Practice Address - Zip Code:48640-2669
Practice Address - Country:US
Practice Address - Phone:989-832-0042
Practice Address - Fax:989-832-0042
Is Sole Proprietor?:No
Enumeration Date:2007-04-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MI4301065743207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology