Provider Demographics
NPI:1144544081
Name:ANTOINE COPTY OD PC
Entity type:Organization
Organization Name:ANTOINE COPTY OD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPTOMETRIST
Authorized Official - Prefix:DR
Authorized Official - First Name:ANTOINE
Authorized Official - Middle Name:
Authorized Official - Last Name:COPTY
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:713-724-8353
Mailing Address - Street 1:2116 35TH ST
Mailing Address - Street 2:1G
Mailing Address - City:ASTORIA
Mailing Address - State:NY
Mailing Address - Zip Code:11105-2147
Mailing Address - Country:US
Mailing Address - Phone:713-724-8353
Mailing Address - Fax:186-654-3570
Practice Address - Street 1:2116 35TH ST
Practice Address - Street 2:1G
Practice Address - City:ASTORIA
Practice Address - State:NY
Practice Address - Zip Code:11105-2147
Practice Address - Country:US
Practice Address - Phone:713-724-8353
Practice Address - Fax:186-654-3570
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-03-22
Last Update Date:2011-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY007503152WC0802X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152WC0802XEye and Vision Services ProvidersOptometristCorneal and Contact ManagementGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYG100022680Medicare PIN