Provider Demographics
NPI:1508857202
Name:COPELAND, CONSTANCE S (OD, PHD)
Entity Type:Individual
Prefix:DR
First Name:CONSTANCE
Middle Name:S
Last Name:COPELAND
Suffix:
Gender:F
Credentials:OD, PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8038 MACINTOSH LN
Mailing Address - Street 2:
Mailing Address - City:ROCKFORD
Mailing Address - State:IL
Mailing Address - Zip Code:61107-5336
Mailing Address - Country:US
Mailing Address - Phone:815-332-6800
Mailing Address - Fax:815-332-6810
Practice Address - Street 1:8038 MACINTOSH LN
Practice Address - Street 2:
Practice Address - City:ROCKFORD
Practice Address - State:IL
Practice Address - Zip Code:61107-5336
Practice Address - Country:US
Practice Address - Phone:815-332-6800
Practice Address - Fax:815-332-6810
Is Sole Proprietor?:No
Enumeration Date:2005-11-02
Last Update Date:2024-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL046011082152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI38723000Medicaid
WI38603100Medicaid
WI38723000Medicaid
WI0299420002Medicare NSC
U71282Medicare UPIN