Provider Demographics
NPI:1730434390
Name:COPELAND, ALEXANDRA (OD)
Entity type:Individual
Prefix:
First Name:ALEXANDRA
Middle Name:
Last Name:COPELAND
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:ALEXANDRA
Other - Middle Name:
Other - Last Name:TROY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OD
Mailing Address - Street 1:7161 W Q AVE
Mailing Address - Street 2:
Mailing Address - City:KALAMAZOO
Mailing Address - State:MI
Mailing Address - Zip Code:49009-5951
Mailing Address - Country:US
Mailing Address - Phone:269-870-7334
Mailing Address - Fax:
Practice Address - Street 1:7161 W Q AVE
Practice Address - Street 2:
Practice Address - City:KALAMAZOO
Practice Address - State:MI
Practice Address - Zip Code:49009-5951
Practice Address - Country:US
Practice Address - Phone:269-870-7334
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-07-19
Last Update Date:2020-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOEG002667152W00000X
IL046010680152WL0500X
MI4901004798152WL0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152WL0500XEye and Vision Services ProvidersOptometristLow Vision Rehabilitation
No152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4901004798OtherLICENSE
PAOEG002667OtherLICENSE
IL046010680OtherIL LICENSE