Provider Demographics
NPI:1336221316
Name:COOPER, RUBY YOUNG (OD)
Entity Type:Individual
Prefix:DR
First Name:RUBY
Middle Name:YOUNG
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 1:7515 BURGESS LANDE
Mailing Address - Street 2:
Mailing Address - City:FT. WASHINGTON
Mailing Address - State:MD
Mailing Address - Zip Code:20744
Mailing Address - Country:US
Mailing Address - Phone:301-736-5600
Mailing Address - Fax:
Practice Address - Street 1:7515 BURGESS LN
Practice Address - Street 2:
Practice Address - City:FT WASHINGTON
Practice Address - State:MD
Practice Address - Zip Code:20744-1710
Practice Address - Country:US
Practice Address - Phone:301-248-6191
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDTA1345152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist