Provider Demographics
NPI:1518939297
Name:COOPER, LAWRENCE NATHAN (MD)
Entity Type:Individual
Prefix:DR
First Name:LAWRENCE
Middle Name:NATHAN
Last Name:COOPER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2500 6TH AVE UNIT 606
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92103-2122
Mailing Address - Country:US
Mailing Address - Phone:619-990-5656
Mailing Address - Fax:619-432-1853
Practice Address - Street 1:2500 SIXTH AVE.
Practice Address - Street 2:UNIT 606
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92103-2122
Practice Address - Country:US
Practice Address - Phone:619-990-5656
Practice Address - Fax:619-432-1853
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-06
Last Update Date:2023-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG27092208D00000X, 207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
No208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G270920Medicaid
CAG270920Medicare ID - Type Unspecified
A43216Medicare UPIN