Provider Demographics
NPI:1508923251
Name:COOPER OPTICAL COMPANY, INC.
Entity Type:Organization
Organization Name:COOPER OPTICAL COMPANY, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SEC.TRES.
Authorized Official - Prefix:MRS
Authorized Official - First Name:BETTY
Authorized Official - Middle Name:J
Authorized Official - Last Name:COOPER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:903-753-7606
Mailing Address - Street 1:306 W WHALEY ST
Mailing Address - Street 2:
Mailing Address - City:LONGVIEW
Mailing Address - State:TX
Mailing Address - Zip Code:75601-6321
Mailing Address - Country:US
Mailing Address - Phone:903-753-7606
Mailing Address - Fax:
Practice Address - Street 1:306 W WHALEY ST
Practice Address - Street 2:
Practice Address - City:LONGVIEW
Practice Address - State:TX
Practice Address - Zip Code:75601-6321
Practice Address - Country:US
Practice Address - Phone:903-753-7606
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-02
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0645210001Medicare ID - Type Unspecified