Provider Demographics
NPI:1952487514
Name:KOPAN, DEAN (OD,)
Entity Type:Individual
Prefix:DR
First Name:DEAN
Middle Name:
Last Name:KOPAN
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 1:4021 W SYLVANIA AVE
Mailing Address - Street 2:
Mailing Address - City:TOLEDO
Mailing Address - State:OH
Mailing Address - Zip Code:43623-4428
Mailing Address - Country:US
Mailing Address - Phone:419-475-6181
Mailing Address - Fax:419-475-5720
Practice Address - Street 1:4021 W SYLVANIA AVE
Practice Address - Street 2:
Practice Address - City:TOLEDO
Practice Address - State:OH
Practice Address - Zip Code:43623-4428
Practice Address - Country:US
Practice Address - Phone:419-475-6181
Practice Address - Fax:419-475-5720
Is Sole Proprietor?:No
Enumeration Date:2006-10-27
Last Update Date:2010-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH4117 T68152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0854286Medicaid
OH0854286Medicaid
OHDO9328471Medicare ID - Type Unspecified