Provider Demographics
NPI:1295800050
Name:COOPER, JEFFREY (OD)
Entity type:Individual
Prefix:DR
First Name:JEFFREY
Middle Name:
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 1:539 PARK AVE
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10065-8167
Mailing Address - Country:US
Mailing Address - Phone:212-758-0772
Mailing Address - Fax:
Practice Address - Street 1:1448 86TH ST
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11228-3429
Practice Address - Country:US
Practice Address - Phone:718-236-4186
Practice Address - Fax:718-837-0341
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-21
Last Update Date:2015-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYVUT003001152WC0802X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152WC0802XEye and Vision Services ProvidersOptometristCorneal and Contact Management
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01557675Medicaid
C27202Medicare PIN
NYP48939Medicare UPIN