Organization
COPPEDGE EYECARE, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JOHN CASEY COPPEDGE O.D. (MANAGER)
(352) 796-2141
Entity
Organization
Contact information
Practice address
86 PONCE DE LEON BLVD, BROOKSVILLE, FL 34601-2818
(352) 796-2141
Mailing address
86 PONCE DE LEON BLVD, BROOKSVILLE, FL 34601-2818
(352) 796-2141
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
OPC004216
FL
Other
Enumeration date
07/01/2009
Last updated
09/13/2010
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