Provider Demographics
NPI:1255619771
Name:COOPER, STEPHANIE MARIE (OD)
Entity type:Individual
Prefix:DR
First Name:STEPHANIE
Middle Name:MARIE
Last Name:COOPER
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2424 E 21ST ST STE 200
Mailing Address - Street 2:
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74114-1736
Mailing Address - Country:US
Mailing Address - Phone:918-949-4577
Mailing Address - Fax:918-949-3785
Practice Address - Street 1:2424 E 21ST ST STE 200
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74114-1736
Practice Address - Country:US
Practice Address - Phone:918-949-4577
Practice Address - Fax:918-949-3785
Is Sole Proprietor?:No
Enumeration Date:2011-08-01
Last Update Date:2020-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK2691152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist