Provider Demographics
NPI:1932283579
Name:COOPER-GREGORY, NANCY CLARE (OD)
Entity Type:Individual
Prefix:DR
First Name:NANCY
Middle Name:CLARE
Last Name:COOPER-GREGORY
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:5716 WHISTLING WINDS WALK
Mailing Address - Street 2:
Mailing Address - City:CLARKSVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:21029-1662
Mailing Address - Country:US
Mailing Address - Phone:443-535-0828
Mailing Address - Fax:
Practice Address - Street 1:1311 LONDONTOWN BLVD STE 100
Practice Address - Street 2:
Practice Address - City:ELDERSBURG
Practice Address - State:MD
Practice Address - Zip Code:21784-7074
Practice Address - Country:US
Practice Address - Phone:410-795-5588
Practice Address - Fax:410-795-5648
Is Sole Proprietor?:No
Enumeration Date:2006-10-24
Last Update Date:2023-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDTA1022152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
U49477Medicare UPIN