Provider Demographics
NPI:1891826533
Name:COOPER, ALAN ROBERT (OD)
Entity Type:Individual
Prefix:DR
First Name:ALAN
Middle Name:ROBERT
Last Name:COOPER
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 1:136 MARKET ST
Mailing Address - Street 2:
Mailing Address - City:PATERSON
Mailing Address - State:NJ
Mailing Address - Zip Code:07505-1402
Mailing Address - Country:US
Mailing Address - Phone:973-278-5300
Mailing Address - Fax:973-523-5856
Practice Address - Street 1:136 MARKET ST
Practice Address - Street 2:
Practice Address - City:PATERSON
Practice Address - State:NJ
Practice Address - Zip Code:07505-1402
Practice Address - Country:US
Practice Address - Phone:973-278-5300
Practice Address - Fax:973-523-5856
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-07
Last Update Date:2009-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ27OA00276900152W00000X
NJ27TO00045300152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ3468208Medicaid
U11913Medicare UPIN
521436Medicare ID - Type Unspecified