Provider Demographics
NPI:1417944307
Name:KOOP, RICHARD (OD)
Entity Type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:
Last Name:KOOP
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 1:220 N MCKEMY AVE
Mailing Address - Street 2:
Mailing Address - City:CHANDLER
Mailing Address - State:AZ
Mailing Address - Zip Code:85226-2654
Mailing Address - Country:US
Mailing Address - Phone:480-961-1865
Mailing Address - Fax:480-961-4605
Practice Address - Street 1:2501 W HAPPY VALLEY RD
Practice Address - Street 2:#32-1050
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85085-3701
Practice Address - Country:US
Practice Address - Phone:623-869-0253
Practice Address - Fax:623-869-0270
Is Sole Proprietor?:No
Enumeration Date:2005-10-05
Last Update Date:2014-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ1067152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZZ65501Medicare PIN
AZZ163014Medicare PIN
AZZ162074Medicare PIN
AZU34718Medicare UPIN