Provider Demographics
NPI:1770642175
Name:COPPOLA, WILLIAM VINCENT (OD)
Entity Type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:VINCENT
Last Name:COPPOLA
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:PO BOX 568
Mailing Address - Street 2:
Mailing Address - City:ROCKLAND
Mailing Address - State:ME
Mailing Address - Zip Code:04841-0568
Mailing Address - Country:US
Mailing Address - Phone:207-594-9555
Mailing Address - Fax:207-594-2410
Practice Address - Street 1:20 OAK ST.
Practice Address - Street 2:
Practice Address - City:ROCKLAND
Practice Address - State:ME
Practice Address - Zip Code:04841
Practice Address - Country:US
Practice Address - Phone:207-594-9555
Practice Address - Fax:207-594-2410
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-08
Last Update Date:2011-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEOPT565152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME135240000Medicaid
MECO709280Medicare ID - Type Unspecified
MET79604Medicare UPIN