Provider Demographics
NPI:1578535654
Name:DRS. COOPER & BANNINGER, LLC.
Entity Type:Organization
Organization Name:DRS. COOPER & BANNINGER, LLC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/OPTOMETRIST
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:LAWRENCE
Authorized Official - Last Name:COOPER
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:785-823-6391
Mailing Address - Street 1:112 W MAIN ST
Mailing Address - Street 2:
Mailing Address - City:BELOIT
Mailing Address - State:KS
Mailing Address - Zip Code:67420-2745
Mailing Address - Country:US
Mailing Address - Phone:785-738-4200
Mailing Address - Fax:785-738-4201
Practice Address - Street 1:112 W MAIN ST
Practice Address - Street 2:
Practice Address - City:BELOIT
Practice Address - State:KS
Practice Address - Zip Code:67420-2745
Practice Address - Country:US
Practice Address - Phone:785-738-4200
Practice Address - Fax:785-738-4201
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-02-03
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS1296152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS043382OtherBCBS
KS043382OtherBCBS