Provider Demographics
NPI:1629067020
Name:COPELY, A.R JR (OD)
Entity Type:Individual
Prefix:DR
First Name:A.R
Middle Name:
Last Name:COPELY
Suffix:JR
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 1:1455 W HOLDEN AVE
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32839-1702
Mailing Address - Country:US
Mailing Address - Phone:407-855-3100
Mailing Address - Fax:407-855-5281
Practice Address - Street 1:1455 W HOLDEN AVE
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32839-1702
Practice Address - Country:US
Practice Address - Phone:407-855-3100
Practice Address - Fax:407-855-5281
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-18
Last Update Date:2020-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOP000913152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL104626200Medicaid
FLT84053Medicare UPIN
FL078252100Medicaid