Provider Demographics
NPI:1841571262
Name:COPPESS, ASHLEY JANEL (OD)
Entity Type:Individual
Prefix:DR
First Name:ASHLEY
Middle Name:JANEL
Last Name:COPPESS
Suffix:
Gender:F
Credentials:OD
Other - Prefix:DR
Other - First Name:ASHLEY
Other - Middle Name:JANEL
Other - Last Name:MOSER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OD
Mailing Address - Street 1:9568 N STATE ROAD 37
Mailing Address - Street 2:
Mailing Address - City:ELWOOD
Mailing Address - State:IN
Mailing Address - Zip Code:46036-8846
Mailing Address - Country:US
Mailing Address - Phone:765-623-6161
Mailing Address - Fax:
Practice Address - Street 1:9568 N STATE ROAD 37
Practice Address - Street 2:
Practice Address - City:ELWOOD
Practice Address - State:IN
Practice Address - Zip Code:46036-8846
Practice Address - Country:US
Practice Address - Phone:765-623-6161
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-08-30
Last Update Date:2015-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN18003693A152W00000X
OH6149152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0073785Medicaid
OHH120800Medicare PIN
OHP01330586Medicare PIN