Provider Demographics
NPI:1851326185
Name:KLOPPING, MICHAEL KENT (OD)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:KENT
Last Name:KLOPPING
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5345 N EL DORADO ST STE 10
Mailing Address - Street 2:
Mailing Address - City:STOCKTON
Mailing Address - State:CA
Mailing Address - Zip Code:95207-5856
Mailing Address - Country:US
Mailing Address - Phone:209-957-2824
Mailing Address - Fax:209-478-6001
Practice Address - Street 1:5345 N EL DORADO ST STE 10
Practice Address - Street 2:
Practice Address - City:STOCKTON
Practice Address - State:CA
Practice Address - Zip Code:95207-5856
Practice Address - Country:US
Practice Address - Phone:209-957-2824
Practice Address - Fax:209-478-6001
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-12
Last Update Date:2008-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CASD0079750152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CASD0079750Medicaid
CASD0079750Medicare PIN
CASD0079750Medicaid