Provider Demographics
NPI:1659448033
Name:COOPER, DAWN A (OPTICIAN)
Entity Type:Individual
Prefix:MRS
First Name:DAWN
Middle Name:A
Last Name:COOPER
Suffix:
Gender:F
Credentials:OPTICIAN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:639 BROADWAY
Mailing Address - Street 2:
Mailing Address - City:LONG BRANCH
Mailing Address - State:NJ
Mailing Address - Zip Code:07740-5443
Mailing Address - Country:US
Mailing Address - Phone:732-229-3992
Mailing Address - Fax:732-229-4102
Practice Address - Street 1:639 BROADWAY
Practice Address - Street 2:
Practice Address - City:LONG BRANCH
Practice Address - State:NJ
Practice Address - Zip Code:07740-5443
Practice Address - Country:US
Practice Address - Phone:732-229-3992
Practice Address - Fax:732-229-4102
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-29
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJD1325156FX1100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1100XEye and Vision Services ProvidersTechnician/TechnologistOphthalmic