Provider Demographics
NPI:1760488951
Name:COPE, JOE D (OD)
Entity Type:Individual
Prefix:DR
First Name:JOE
Middle Name:D
Last Name:COPE
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 1:2010 S MUSKOGEE AVE
Mailing Address - Street 2:
Mailing Address - City:TAHLEQUAH
Mailing Address - State:OK
Mailing Address - Zip Code:74464-5439
Mailing Address - Country:US
Mailing Address - Phone:918-456-0020
Mailing Address - Fax:918-453-0020
Practice Address - Street 1:2010 S MUSKOGEE AVE
Practice Address - Street 2:
Practice Address - City:TAHLEQUAH
Practice Address - State:OK
Practice Address - Zip Code:74464-5439
Practice Address - Country:US
Practice Address - Phone:918-456-0020
Practice Address - Fax:918-453-0020
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-22
Last Update Date:2008-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK917152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK100764330AMedicaid
OK$$$$$$$$$-009OtherBC/BS OF OKLAHOMA
OK100764330AMedicaid
OKT40405Medicare UPIN