1083608608 NPI number — DR. JEFFREY A. COPPES O.D.

Table of content: DR. JEFFREY A. COPPES O.D. (NPI 1083608608)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1083608608 NPI number — DR. JEFFREY A. COPPES O.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
COPPES
Provider First Name:
JEFFREY
Provider Middle Name:
A.
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
O.D.
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1083608608
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/31/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
6502 GRAPE ROAD
Provider Second Line Business Mailing Address:
SUITE 898
Provider Business Mailing Address City Name:
MISHAWAKA
Provider Business Mailing Address State Name:
IN
Provider Business Mailing Address Postal Code:
46545
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
574-277-7723
Provider Business Mailing Address Fax Number:
574-277-9698

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
6502 GRAPE ROAD
Provider Second Line Business Practice Location Address:
SUITE 898
Provider Business Practice Location Address City Name:
MISHAWAKA
Provider Business Practice Location Address State Name:
IN
Provider Business Practice Location Address Postal Code:
46545
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
574-277-7723
Provider Business Practice Location Address Fax Number:
574-277-9698
Provider Enumeration Date:
09/09/2005

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 152W00000X , with the licence number:  18002135A , registered in the state of IN ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 152W00000X , with the licence number: 18002135B , registered in the state of IN ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: IN2135 . This is a "EYE MED ELKHART" identifier , issued by the state of ( IN ) . This identifiers is of the category "OTHER".
  • Identifier: IN72135 . This is a "VISIONBENEFITSAMERICA ELK" identifier , issued by the state of ( IN ) . This identifiers is of the category "OTHER".
  • Identifier: 000000273033 . This is a "BLUE CROSS ELKHART" identifier , issued by the state of ( IN ) . This identifiers is of the category "OTHER".
  • Identifier: 01172 . This is a "SPECTERA ELKHART" identifier , issued by the state of ( IN ) . This identifiers is of the category "OTHER".
  • Identifier: IN2135 . This is a "EYEMED" identifier , issued by the state of ( IN ) . This identifiers is of the category "OTHER".
  • Identifier: 100414710 , issued by the state of ( IN ) . This identifiers is of the category "MEDICAID".
  • Identifier: 2550910002 . This is a "DMERC ELKHART" identifier , issued by the state of ( IN ) . This identifiers is of the category "OTHER".
  • Identifier: 351368448 . This is a "VISION SERVICE PLAN" identifier , issued by the state of ( IN ) . This identifiers is of the category "OTHER".




Copyright © 2007-2025 www.npivalidator.com