Provider Demographics
NPI:1174664734
Name:KOPOLOW & GIRISGEN PROFESSIONAL CORPORATION
Entity Type:Organization
Organization Name:KOPOLOW & GIRISGEN PROFESSIONAL CORPORATION
Other - Org Name:DRS. KOPOLOW & GIRISGEN, O.D., P.C.
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:STEVE
Authorized Official - Middle Name:
Authorized Official - Last Name:GIRISGEN
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:702-341-7254
Mailing Address - Street 1:9975 S EASTERN AVE
Mailing Address - Street 2:STE 100
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89183-7950
Mailing Address - Country:US
Mailing Address - Phone:702-341-7254
Mailing Address - Fax:
Practice Address - Street 1:9975 S EASTERN AVE
Practice Address - Street 2:STE 100
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89183-7950
Practice Address - Country:US
Practice Address - Phone:702-341-7254
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-08
Last Update Date:2020-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV100507990Medicaid
NVV102039Medicare PIN