Individual
ALEXANDRA COPELAND
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
OD
Contact information
Practice address
7161 W Q AVE, KALAMAZOO, MI 49009-5951
(269) 870-7334
Mailing address
7161 W Q AVE, KALAMAZOO, MI 49009-5951
(269) 870-7334
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
OEG002667
PA
152WL0500X
Low Vision Rehabilitation Optometrist
046010680
IL
152WL0500X
Low Vision Rehabilitation Optometrist
Primary
4901004798
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
046010680
IL LICENSE
IL
01
—
4901004798
LICENSE
MI
01
—
OEG002667
LICENSE
PA
Enumeration date
07/19/2012
Last updated
07/17/2020
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