Individual
PAUL K COPPOLA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
OD
Contact information
Practice address
111 RETREAT ST, WESTMINSTER, SC 29693-1724
(864) 647-5076
(864) 647-0828
Mailing address
111 RETREAT ST, WESTMINSTER, SC 29693-1724
(864) 647-5076
(864) 647-0828
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
1040
SC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
410037186
RAILROAD MEDICARE
GA
05
—
D10405
—
SC
Enumeration date
10/23/2006
Last updated
12/30/2016
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