Provider Demographics
NPI:1750460267
Name:KOPITAS, EVON (PA-C)
Entity Type:Individual
Prefix:MS
First Name:EVON
Middle Name:
Last Name:KOPITAS
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:875 E 22ND ST APT 412
Mailing Address - Street 2:
Mailing Address - City:LOMBARD
Mailing Address - State:IL
Mailing Address - Zip Code:60148-5026
Mailing Address - Country:US
Mailing Address - Phone:630-953-9053
Mailing Address - Fax:
Practice Address - Street 1:5TH AVENUE AND ROOSEVELT ROAD
Practice Address - Street 2:ATTN: EYE CLINIC A116L
Practice Address - City:HINES
Practice Address - State:IL
Practice Address - Zip Code:60141
Practice Address - Country:US
Practice Address - Phone:708-202-2061
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical