Provider Demographics
NPI:1609903038
Name:KOPLOS, ANGELA C (OD)
Entity Type:Individual
Prefix:
First Name:ANGELA
Middle Name:C
Last Name:KOPLOS
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 1:3800 N MESA ST STE B1
Mailing Address - Street 2:
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79902-1535
Mailing Address - Country:US
Mailing Address - Phone:915-533-1811
Mailing Address - Fax:855-728-1614
Practice Address - Street 1:3800 N MESA ST STE B1
Practice Address - Street 2:
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79902-1535
Practice Address - Country:US
Practice Address - Phone:915-533-1811
Practice Address - Fax:855-728-1614
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-27
Last Update Date:2015-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX5414T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX019089401Medicaid
TX019089401Medicaid
U72843Medicare UPIN