Provider Demographics
NPI:1407811466
Name:COPELAND, GREGORY F (OD)
Entity Type:Individual
Prefix:
First Name:GREGORY
Middle Name:F
Last Name:COPELAND
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 1:1100 W OKLAHOMA AVE
Mailing Address - Street 2:
Mailing Address - City:ULYSSES
Mailing Address - State:KS
Mailing Address - Zip Code:67880-2359
Mailing Address - Country:US
Mailing Address - Phone:620-356-4094
Mailing Address - Fax:620-356-1978
Practice Address - Street 1:1100 W OKLAHOMA AVE
Practice Address - Street 2:
Practice Address - City:ULYSSES
Practice Address - State:KS
Practice Address - Zip Code:67880-2359
Practice Address - Country:US
Practice Address - Phone:620-356-4094
Practice Address - Fax:620-356-1978
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-20
Last Update Date:2008-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KSKS10262152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS100219550CMedicaid
KSP00059515OtherRAILROAD MEDICARE
KSP00059515OtherRAILROAD MEDICARE
T44076Medicare UPIN