Provider Demographics
NPI:1821271354
Name:JEFFREY COOPER O.D., P.C.
Entity Type:Organization
Organization Name:JEFFREY COOPER O.D., P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPTOMETRIST
Authorized Official - Prefix:DR
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:
Authorized Official - Last Name:COLAVITO
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:212-758-0772
Mailing Address - Street 1:539 PARK AVE
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10065-8167
Mailing Address - Country:US
Mailing Address - Phone:212-758-0772
Mailing Address - Fax:212-758-3532
Practice Address - Street 1:539 PARK AVE
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10065-8167
Practice Address - Country:US
Practice Address - Phone:212-758-0772
Practice Address - Fax:212-758-3532
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-06
Last Update Date:2007-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYVUT006115152WC0802X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152WC0802XEye and Vision Services ProvidersOptometristCorneal and Contact ManagementGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02118165Medicaid
NYJC0C265B10OtherBC/BS
NYJC0C265B10OtherBC/BS
NYU88839Medicare UPIN