Provider Demographics
NPI:1780611954
Name:COPE, JAMES A IV (OD)
Entity type:Individual
Prefix:
First Name:JAMES
Middle Name:A
Last Name:COPE
Suffix:IV
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Mailing Address - Street 1:48 S MAIN ST
Mailing Address - Street 2:PO BOX 196
Mailing Address - City:NEPHI
Mailing Address - State:UT
Mailing Address - Zip Code:84648-1708
Mailing Address - Country:US
Mailing Address - Phone:435-623-2100
Mailing Address - Fax:435-623-1671
Practice Address - Street 1:48 S MAIN ST
Practice Address - Street 2:
Practice Address - City:NEPHI
Practice Address - State:UT
Practice Address - Zip Code:84648-1708
Practice Address - Country:US
Practice Address - Phone:435-623-2100
Practice Address - Fax:435-623-1671
Is Sole Proprietor?:No
Enumeration Date:2006-06-26
Last Update Date:2007-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT376928-9934152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
UTV77388Medicare UPIN