Provider Demographics
NPI:1376899237
Name:COOPER, ALYSSA ANNE MILLIGAN (OD)
Entity Type:Individual
Prefix:
First Name:ALYSSA
Middle Name:ANNE MILLIGAN
Last Name:COOPER
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11261 NALL AVE
Mailing Address - Street 2:SUITE 192
Mailing Address - City:LEAWOOD
Mailing Address - State:KS
Mailing Address - Zip Code:66211-1669
Mailing Address - Country:US
Mailing Address - Phone:913-261-2020
Mailing Address - Fax:913-671-3225
Practice Address - Street 1:11261 NALL AVE
Practice Address - Street 2:
Practice Address - City:LEAWOOD
Practice Address - State:KS
Practice Address - Zip Code:66211-1669
Practice Address - Country:US
Practice Address - Phone:913-261-2020
Practice Address - Fax:913-261-2090
Is Sole Proprietor?:No
Enumeration Date:2012-07-30
Last Update Date:2019-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS1922152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO4050D0013Medicare PIN
KS405E00019Medicare PIN
MO4050A0012Medicare PIN
MO4050H0012Medicare PIN