Provider Demographics
NPI:1689639429
Name:COOPERMAN, JAMES L (OD)
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:L
Last Name:COOPERMAN
Suffix:
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 1:18449 BROOKHURST ST
Mailing Address - Street 2:STE 6
Mailing Address - City:FOUNTAIN VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:92708-6751
Mailing Address - Country:US
Mailing Address - Phone:714-963-2111
Mailing Address - Fax:714-963-4642
Practice Address - Street 1:18449 BROOKHURST ST
Practice Address - Street 2:STE 6
Practice Address - City:FOUNTAIN VALLEY
Practice Address - State:CA
Practice Address - Zip Code:92708-6751
Practice Address - Country:US
Practice Address - Phone:714-963-2111
Practice Address - Fax:714-963-4642
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-17
Last Update Date:2011-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA7875T152W00000X
CAOP7875T152WC0802X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
No152WC0802XEye and Vision Services ProvidersOptometristCorneal and Contact Management
Provider Identifiers
StateIdentifier IDID TypeIssuer
SDOO78750OtherBLUE SHIELD OF CA
CAP00752634Medicare PIN
SDOO78750OtherBLUE SHIELD OF CA
CA3663840001Medicare NSC
CAOP7875Medicare PIN