Individual
DR. JAN LOUISE COOPER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
O.D., F.A.A.O.
Contact information
Practice address
3693 HIGHLAND AVE, SUITE D, HIGHLAND, CA 92346-2609
(909) 425-2020
(909) 425-2237
Mailing address
101 CHANDLER W, HIGHLAND, CA 92346-5482
(909) 864-0987
(909) 864-0876
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
8696T
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
7053419
MEDICAID PIN
CA
05
—
SD0086960
—
CA
Enumeration date
12/25/2006
Last updated
07/10/2009
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