Provider Demographics
NPI:1629005939
Name:KOPIKO, KAREN (OD, FAAO)
Entity Type:Individual
Prefix:DR
First Name:KAREN
Middle Name:
Last Name:KOPIKO
Suffix:
Gender:F
Credentials:OD, FAAO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:671 PARKER AVE
Mailing Address - Street 2:
Mailing Address - City:RODEO
Mailing Address - State:CA
Mailing Address - Zip Code:94572-1434
Mailing Address - Country:US
Mailing Address - Phone:510-799-4258
Mailing Address - Fax:510-799-6616
Practice Address - Street 1:671 PARKER AVE
Practice Address - Street 2:
Practice Address - City:RODEO
Practice Address - State:CA
Practice Address - Zip Code:94572-1434
Practice Address - Country:US
Practice Address - Phone:510-799-4258
Practice Address - Fax:510-799-6616
Is Sole Proprietor?:No
Enumeration Date:2006-06-26
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA11256T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CASD0112560Medicaid
CASD0112560Medicaid
CASD0112560Medicare ID - Type Unspecified
CASD0112560Medicaid