Kelly M Cooper

Primary specialty

OptometristTaxonomy code 152W00000X

License

TA2775 Issued in MD

Practice address

1013 S Talbot St
Saint Michaels, MD 21663-2637

Phone

(954) 298-9913

NPI assigned

Oct 28, 2020

Last updated

Jun 5, 2023By the provider in NPPES

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in MD

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: No
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Specialty

Optometry

Education

Other, 2020

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Route 33 Eye Care & Optical Boutique LLC

  • Optometrist
  • St. Michael's, MD
  • NPI 1932801362
  Medicare reassignment NPD Authorized official

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1603843200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1685923200000",
    "number": "1124628300",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "510 TENANT CIR",
            "city": "SAINT MICHAELS",
            "state": "MD",
            "postal_code": "216632873"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1013 S TALBOT ST",
            "city": "SAINT MICHAELS",
            "state": "MD",
            "postal_code": "216632637",
            "telephone_number": "954-298-9913"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "COOPER",
        "first_name": "KELLY",
        "middle_name": "M",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2020-10-28",
        "last_updated": "2023-06-05",
        "certification_date": "2023-06-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "MD",
            "license": "TA2775",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Choptank Community Health System Inc (St Michaels Middle High School SBDP)
• Choptank Community Health System Inc (St Michaels Elementary School SBDP)
• Choptank Community Health System Inc (Bay Hundred Health Center)
• Choptank Community Health System, Inc. (St. Michael's Elementary School SBHC)
• Choptank Community Health System, Inc. (St. Michael's Middle/High School SBHC)
• Deborah C. Gootee CRNP-PMH, LLC
• Deck LLC (Medicine Shoppe Pharmacy)
• Gregory Dukes, CRNP
• Carrie Jean Ettinger, CNS
• Stephanie Rejeana Faulkner

• Optometrist in St. Michael's, MD
• Providers in St. Michael's, MD by specialty
• Optometrist in Maryland

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 5, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.