Provider Demographics
NPI:1457670846
Name:COOPER, KIMBERLY MAY (OD)
Entity Type:Individual
Prefix:DR
First Name:KIMBERLY
Middle Name:MAY
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 1:5770 RED ARROW HWY
Mailing Address - Street 2:
Mailing Address - City:STEVENSVILLE
Mailing Address - State:MI
Mailing Address - Zip Code:49127-1159
Mailing Address - Country:US
Mailing Address - Phone:269-367-2626
Mailing Address - Fax:
Practice Address - Street 1:5770 RED ARROW HWY
Practice Address - Street 2:
Practice Address - City:STEVENSVILLE
Practice Address - State:MI
Practice Address - Zip Code:49127-1159
Practice Address - Country:US
Practice Address - Phone:269-367-2626
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-05-25
Last Update Date:2020-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC1562152W00000X
MI4901004536152W00000X
IN18003999A152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist