Provider Demographics
NPI:1497747331
Name:KOPLO, MERRYL S (OD)
Entity Type:Individual
Prefix:DR
First Name:MERRYL
Middle Name:S
Last Name:KOPLO
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1858 N UNIVERSITY DR
Mailing Address - Street 2:
Mailing Address - City:PLANTATION
Mailing Address - State:FL
Mailing Address - Zip Code:33322-4117
Mailing Address - Country:US
Mailing Address - Phone:954-473-6860
Mailing Address - Fax:954-473-8660
Practice Address - Street 1:1858 N UNIVERSITY DR
Practice Address - Street 2:
Practice Address - City:PLANTATION
Practice Address - State:FL
Practice Address - Zip Code:33322-4117
Practice Address - Country:US
Practice Address - Phone:954-473-6860
Practice Address - Fax:954-473-8660
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-17
Last Update Date:2013-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOPC0003131152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLU70192Medicare UPIN
FL5172430001Medicare NSC
FLE0527ZMedicare PIN