Active NPI
Jeffrey A. Coppes, O.D.
- Optometrist
- Mishawaka, IN
National Provider Identifier
1083608608
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Optometrist
- License
- 18002135A
- Practice address
- 6502 Grape Road
Suite 898
Mishawaka, IN 46545 - Phone
- (574) 277-7723
- Fax
- (574) 277-9698
- NPI assigned
- Sep 9, 2005
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Optometrist | 152W00000X | 18002135A | IN | Primary |
| Optometrist | 152W00000X | 18002135B | IN |
Addresses
Primary practice location
6502 Grape Road
Suite 898
Mishawaka, IN 46545
Mailing address
6502 Grape Road
Suite 898
Mishawaka, IN 46545
Phone (574) 277-7723
Other identifiers 8
| Identifier | Type | State | Issuer |
|---|---|---|---|
| IN2135 | Other | IN | EYE MED ELKHART |
| IN72135 | Other | IN | VISIONBENEFITSAMERICA ELK |
| 000000273033 | Other | IN | BLUE CROSS ELKHART |
| 01172 | Other | IN | SPECTERA ELKHART |
| IN2135 | Other | IN | EYEMED |
| 100414710 | Medicaid | IN | |
| 2550910002 | Other | IN | DMERC ELKHART |
| 351368448 | Other | IN | VISION SERVICE PLAN |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 18002135A | IN | MD | Optometrist |
| 18002135B | IN | MD | Optometrist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1126224000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1359590400000",
"number": "1083608608",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "6502 GRAPE ROAD",
"address_2": "SUITE 898",
"city": "MISHAWAKA",
"state": "IN",
"postal_code": "46545",
"telephone_number": "574-277-7723",
"fax_number": "574-277-9698"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "6502 GRAPE ROAD",
"address_2": "SUITE 898",
"city": "MISHAWAKA",
"state": "IN",
"postal_code": "46545",
"telephone_number": "574-277-7723",
"fax_number": "574-277-9698"
}
],
"practiceLocations": [],
"basic": {
"last_name": "COPPES",
"first_name": "JEFFREY",
"middle_name": "A.",
"name_prefix": "Dr.",
"credential": "O.D.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2005-09-09",
"last_updated": "2013-01-31",
"status": "A"
},
"taxonomies": [
{
"code": "152W00000X",
"taxonomy_group": "",
"desc": "Optometrist",
"state": "IN",
"license": "18002135A",
"primary": true
},
{
"code": "152W00000X",
"taxonomy_group": "",
"desc": "Optometrist",
"state": "IN",
"license": "18002135B",
"primary": false
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "EYE MED ELKHART",
"identifier": "IN2135",
"state": "IN"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "VISIONBENEFITSAMERICA ELK",
"identifier": "IN72135",
"state": "IN"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BLUE CROSS ELKHART",
"identifier": "000000273033",
"state": "IN"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "SPECTERA ELKHART",
"identifier": "01172",
"state": "IN"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "EYEMED",
"identifier": "IN2135",
"state": "IN"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "100414710",
"state": "IN"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "DMERC ELKHART",
"identifier": "2550910002",
"state": "IN"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "VISION SERVICE PLAN",
"identifier": "351368448",
"state": "IN"
}
],
"endpoints": [],
"other_names": []
}Other providers in Mishawaka, IN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 31, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.