Individual
DR. LAWRENCE HAYES COPPOCK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
OD
Contact information
Practice address
48 N BROADWAY, PENNSVILLE, NJ 08070-1754
(856) 678-4800
(856) 678-3630
Mailing address
48 N BROADWAY, PENNSVILLE, NJ 08070-1754
(856) 678-4800
(856) 678-3630
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
27OA00420900
NJ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
180031090
PALMETTO GBA
NJ
01
—
223485583
TAX ID
NJ
01
—
2244616000
AMERIHEALTH
NJ
01
—
482523
AETNA
NJ
01
—
65065
OPERATING ENGINEERS 825
NJ
Enumeration date
11/03/2005
Last updated
09/22/2020
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