Provider Demographics
NPI:1497050991
Name:COPPOLA, ELIZABETH (OPTICIAN)
Entity Type:Individual
Prefix:MRS
First Name:ELIZABETH
Middle Name:
Last Name:COPPOLA
Suffix:
Gender:F
Credentials:OPTICIAN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:111 RETREAT ST
Mailing Address - Street 2:
Mailing Address - City:WESTMINSTER
Mailing Address - State:SC
Mailing Address - Zip Code:29693-1724
Mailing Address - Country:US
Mailing Address - Phone:864-647-5076
Mailing Address - Fax:864-647-0828
Practice Address - Street 1:111 RETREAT ST
Practice Address - Street 2:
Practice Address - City:WESTMINSTER
Practice Address - State:SC
Practice Address - Zip Code:29693-1724
Practice Address - Country:US
Practice Address - Phone:864-647-5076
Practice Address - Fax:864-647-0828
Is Sole Proprietor?:Yes
Enumeration Date:2011-01-14
Last Update Date:2011-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC165252156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC165252OtherOPTICIAN