Provider Demographics
NPI:1730225996
Name:COOPER, BRAD LEE (OD)
Entity type:Individual
Prefix:DR
First Name:BRAD
Middle Name:LEE
Last Name:COOPER
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Mailing Address - Street 1:1193 PLEASANT OAKS DR
Mailing Address - Street 2:
Mailing Address - City:LEWISVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:75067-2010
Mailing Address - Country:US
Mailing Address - Phone:972-315-2051
Mailing Address - Fax:
Practice Address - Street 1:1515 S LOOP 288
Practice Address - Street 2:
Practice Address - City:DENTON
Practice Address - State:TX
Practice Address - Zip Code:76205-4729
Practice Address - Country:US
Practice Address - Phone:940-384-0424
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXTX3165T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist