Provider Demographics
NPI:1063566362
Name:COOPERATIVE OPTICAL SERVICES, INC
Entity type:Organization
Organization Name:COOPERATIVE OPTICAL SERVICES, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:MR
Authorized Official - First Name:THADDEUS
Authorized Official - Middle Name:J
Authorized Official - Last Name:WINIARSKI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:313-366-5100
Mailing Address - Street 1:2424 E 8 MILE RD
Mailing Address - Street 2:
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48234-1010
Mailing Address - Country:US
Mailing Address - Phone:313-366-5100
Mailing Address - Fax:313-366-2246
Practice Address - Street 1:25952 W. SEVEN MILE RD
Practice Address - Street 2:A
Practice Address - City:LIVONIA
Practice Address - State:MI
Practice Address - Zip Code:48452-1997
Practice Address - Country:US
Practice Address - Phone:248-476-5350
Practice Address - Fax:248-476-5355
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-23
Last Update Date:2008-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIOH27866Medicare ID - Type Unspecified