Provider Demographics
NPI:1669672044
Name:A. R. COPELY, JR, PA
Entity Type:Organization
Organization Name:A. R. COPELY, JR, PA
Other - Org Name:COPELY EYE CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:ANDREW
Authorized Official - Middle Name:RICHARD
Authorized Official - Last Name:COPELY
Authorized Official - Suffix:JR
Authorized Official - Credentials:OD
Authorized Official - Phone:407-855-3100
Mailing Address - Street 1:1455 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 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
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-23
Last Update Date:2008-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOPC913261QM2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL410003018OtherRAILROAD MEDICARE
FL078252100Medicaid
FL19238OtherBLUE CROSS & BLUE SHIELD
FL929807OtherAETNA
FL4754932OtherCIGNA
FLT-84053Medicare UPIN
FL19238OtherBLUE CROSS & BLUE SHIELD