Provider Demographics
NPI:1134800071
Name:FREE, COOPER (OD)
Entity type:Individual
Prefix:
First Name:COOPER
Middle Name:
Last Name:FREE
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 1:1009 TEXAS ST
Mailing Address - Street 2:
Mailing Address - City:WOODWARD
Mailing Address - State:OK
Mailing Address - Zip Code:73801-3127
Mailing Address - Country:US
Mailing Address - Phone:580-254-8020
Mailing Address - Fax:580-254-8377
Practice Address - Street 1:1009 TEXAS ST
Practice Address - Street 2:
Practice Address - City:WOODWARD
Practice Address - State:OK
Practice Address - Zip Code:73801-3127
Practice Address - Country:US
Practice Address - Phone:580-254-8020
Practice Address - Fax:580-254-8377
Is Sole Proprietor?:No
Enumeration Date:2023-07-25
Last Update Date:2023-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK3220152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK3220OtherOK STATE BOARD OF OPTOMETRY