Provider Demographics
NPI:1821168394
Name:COPE, DEBORAH WAGNER (OD)
Entity Type:Individual
Prefix:DR
First Name:DEBORAH
Middle Name:WAGNER
Last Name:COPE
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:DEBORAH
Other - Middle Name:ROSE
Other - Last Name:WAGNER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:955 W SOUTHERN AVE STE 101
Mailing Address - Street 2:
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85210-4903
Mailing Address - Country:US
Mailing Address - Phone:480-961-1865
Mailing Address - Fax:480-893-8172
Practice Address - Street 1:20928 N JOHN WAYNE PKWY STE C6
Practice Address - Street 2:
Practice Address - City:MARICOPA
Practice Address - State:AZ
Practice Address - Zip Code:85139-2924
Practice Address - Country:US
Practice Address - Phone:520-316-4388
Practice Address - Fax:520-316-4393
Is Sole Proprietor?:No
Enumeration Date:2006-11-09
Last Update Date:2022-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL046008156152W00000X
AZOPT-002069152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist