Provider Demographics
NPI:1356492789
Name:KOPPEL, LIOR (OD)
Entity Type:Individual
Prefix:DR
First Name:LIOR
Middle Name:
Last Name:KOPPEL
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:911 OAK TREE AVE STE C
Mailing Address - Street 2:
Mailing Address - City:SOUTH PLAINFIELD
Mailing Address - State:NJ
Mailing Address - Zip Code:07080-5130
Mailing Address - Country:US
Mailing Address - Phone:908-822-1100
Mailing Address - Fax:908-822-1102
Practice Address - Street 1:911 OAK TREE AVE STE C
Practice Address - Street 2:
Practice Address - City:SOUTH PLAINFIELD
Practice Address - State:NJ
Practice Address - Zip Code:07080-5130
Practice Address - Country:US
Practice Address - Phone:908-822-1100
Practice Address - Fax:908-822-1102
Is Sole Proprietor?:No
Enumeration Date:2007-01-14
Last Update Date:2011-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ0A05164152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ6330100Medicaid
045082Medicare ID - Type Unspecified
NJ6330100Medicaid