Individual
DR. BENJAMIN D COOPER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
O.D.
Contact information
Practice address
223 SENECA LN, SAN CARLOS, AZ 85550
(928) 475-7244
(928) 475-7370
Mailing address
PO BOX 208, SAN CARLOS, AZ 85550-0208
(928) 475-7244
(928) 475-7370
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
1795
AZ
152W00000X
Optometrist
2003002705
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
185037
—
AZ
Enumeration date
01/08/2007
Last updated
11/12/2013
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