Provider Demographics
NPI:1487178950
Name:KLOPP, JUSTIN MARK (OD)
Entity Type:Individual
Prefix:DR
First Name:JUSTIN
Middle Name:MARK
Last Name:KLOPP
Suffix:
Gender:M
Credentials:OD
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Mailing Address - Street 1:5856 COLUMBIA CIR S
Mailing Address - Street 2:
Mailing Address - City:GREENWOOD
Mailing Address - State:IN
Mailing Address - Zip Code:46142-9150
Mailing Address - Country:US
Mailing Address - Phone:260-525-8870
Mailing Address - Fax:
Practice Address - Street 1:5250 E US HIGHWAY 36 STE 240
Practice Address - Street 2:
Practice Address - City:AVON
Practice Address - State:IN
Practice Address - Zip Code:46123-9142
Practice Address - Country:US
Practice Address - Phone:317-745-3377
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-07-27
Last Update Date:2017-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN18004024152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist