Provider Demographics
NPI:1689728438
Name:COOPERATIVE OPTICAL SERVICES, INC.
Entity Type:Organization
Organization Name:COOPERATIVE OPTICAL SERVICES, INC.
Other - Org Name:CO/OP OPTICAL VISION DESIGNS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGE CARE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:CHRISTELL
Authorized Official - Middle Name:
Authorized Official - Last Name:JONES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:313-366-5100
Mailing Address - Street 1:2424 E 8 MILE RD
Mailing Address - Street 2:
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48234-1010
Mailing Address - Country:US
Mailing Address - Phone:313-366-5100
Mailing Address - Fax:313-366-2246
Practice Address - Street 1:2763 UNIVERSITY DR
Practice Address - Street 2:
Practice Address - City:AUBURN HILLS
Practice Address - State:MI
Practice Address - Zip Code:48326-2542
Practice Address - Country:US
Practice Address - Phone:248-377-4270
Practice Address - Fax:248-377-4272
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-22
Last Update Date:2018-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI=========OtherTAX ID
MIOH27866Medicare ID - Type Unspecified