Provider Demographics
NPI:1528321056
Name:COOPER, DONNA HUEI-JU (OD)
Entity type:Individual
Prefix:MRS
First Name:DONNA
Middle Name:HUEI-JU
Last Name:COOPER
Suffix:
Gender:F
Credentials:OD
Other - Prefix:MS
Other - First Name:DONNA
Other - Middle Name:HUEI-JU
Other - Last Name:TSAI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OD
Mailing Address - Street 1:2730 WILSHIRE BLVD
Mailing Address - Street 2:545
Mailing Address - City:SANTA MONICA
Mailing Address - State:CA
Mailing Address - Zip Code:90403
Mailing Address - Country:US
Mailing Address - Phone:310-315-9122
Mailing Address - Fax:310-315-9122
Practice Address - Street 1:2730 WILSHIRE BLVD
Practice Address - Street 2:STE 545
Practice Address - City:SANTA MONICA
Practice Address - State:CA
Practice Address - Zip Code:90403
Practice Address - Country:US
Practice Address - Phone:310-315-9122
Practice Address - Fax:310-315-9122
Is Sole Proprietor?:No
Enumeration Date:2012-06-19
Last Update Date:2015-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA14440152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAGH517AMedicare PIN