Provider Demographics
NPI:1639240310
Name:COOPER, THEODORE STEPHEN JR (OD)
Entity Type:Individual
Prefix:DR
First Name:THEODORE
Middle Name:STEPHEN
Last Name:COOPER
Suffix:JR
Gender:M
Credentials:OD
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Mailing Address - Street 1:2028 W POPLAR AVE
Mailing Address - Street 2:SUITE 102
Mailing Address - City:COLLIERVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:38017-0618
Mailing Address - Country:US
Mailing Address - Phone:901-850-7900
Mailing Address - Fax:901-850-7997
Practice Address - Street 1:2028 W POPLAR AVE
Practice Address - Street 2:SUITE 102
Practice Address - City:COLLIERVILLE
Practice Address - State:TN
Practice Address - Zip Code:38017-0618
Practice Address - Country:US
Practice Address - Phone:901-850-7900
Practice Address - Fax:901-850-7997
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-13
Last Update Date:2007-11-01
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
TNT2319152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist