Provider Demographics
NPI:1205939642
Name:COOPER, MORLEY PHILLIPS (OD)
Entity type:Individual
Prefix:
First Name:MORLEY
Middle Name:PHILLIPS
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 1:8801 HORIZON BLVD NE
Mailing Address - Street 2:SUITE 360
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87113-1533
Mailing Address - Country:US
Mailing Address - Phone:505-828-4923
Mailing Address - Fax:505-213-0103
Practice Address - Street 1:806 DR. MLK JR. AVENUE, NE
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87102-3657
Practice Address - Country:US
Practice Address - Phone:505-842-6575
Practice Address - Fax:505-213-0103
Is Sole Proprietor?:No
Enumeration Date:2006-09-07
Last Update Date:2008-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM524152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM08759278Medicaid
NMT89187Medicare UPIN
NM345612801Medicare ID - Type Unspecified