Provider Demographics
NPI:1265715742
Name:COOPER, JULIA ADELE (OD)
Entity type:Individual
Prefix:DR
First Name:JULIA
Middle Name:ADELE
Last Name:COOPER
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15 MALAGA DR
Mailing Address - Street 2:
Mailing Address - City:EWING
Mailing Address - State:NJ
Mailing Address - Zip Code:08638-1311
Mailing Address - Country:US
Mailing Address - Phone:910-616-0050
Mailing Address - Fax:
Practice Address - Street 1:2465 S BROAD ST
Practice Address - Street 2:
Practice Address - City:TRENTON
Practice Address - State:NJ
Practice Address - Zip Code:08610-4700
Practice Address - Country:US
Practice Address - Phone:609-528-4571
Practice Address - Fax:609-528-4577
Is Sole Proprietor?:No
Enumeration Date:2011-09-21
Last Update Date:2011-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ27OA00632400152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist