Provider Demographics
NPI:1629050224
Name:COPELAND, FRANK RODNEY
Entity Type:Individual
Prefix:
First Name:FRANK
Middle Name:RODNEY
Last Name:COPELAND
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2405 CENTRAL AVE
Mailing Address - Street 2:
Mailing Address - City:DODGE CITY
Mailing Address - State:KS
Mailing Address - Zip Code:67801-6206
Mailing Address - Country:US
Mailing Address - Phone:620-227-2471
Mailing Address - Fax:
Practice Address - Street 1:2405 CENTRAL AVE
Practice Address - Street 2:
Practice Address - City:DODGE CITY
Practice Address - State:KS
Practice Address - Zip Code:67801-6206
Practice Address - Country:US
Practice Address - Phone:620-227-2471
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-18
Last Update Date:2008-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS1149-3152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS017134OtherBCBS
KS017134OtherBCBS
KS017134Medicare ID - Type Unspecified
KS0441980001Medicare NSC