Provider Demographics
NPI:1538290002
Name:COOPERMAN, ALAN BEN (OD)
Entity Type:Individual
Prefix:DR
First Name:ALAN
Middle Name:BEN
Last Name:COOPERMAN
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18 SURF WATER CT
Mailing Address - Street 2:
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95831-5583
Mailing Address - Country:US
Mailing Address - Phone:916-281-8712
Mailing Address - Fax:
Practice Address - Street 1:3661 TRUXEL RD
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95834-3604
Practice Address - Country:US
Practice Address - Phone:916-928-6097
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA6190T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist