Provider Demographics
NPI:1861044125
Name:KOPECHEK, JILL (OD)
Entity Type:Individual
Prefix:
First Name:JILL
Middle Name:
Last Name:KOPECHEK
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 1:7727 STRAWBERRY FLDS
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43235-8955
Mailing Address - Country:US
Mailing Address - Phone:937-409-5531
Mailing Address - Fax:
Practice Address - Street 1:1558 COSHOCTON AVE
Practice Address - Street 2:
Practice Address - City:MOUNT VERNON
Practice Address - State:OH
Practice Address - Zip Code:43050-5416
Practice Address - Country:US
Practice Address - Phone:937-409-5531
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-07-16
Last Update Date:2019-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHOPT.006752152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist