Provider Demographics
NPI:1013068048
Name:COPOULOS, KATRINA (OD)
Entity Type:Individual
Prefix:DR
First Name:KATRINA
Middle Name:
Last Name:COPOULOS
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 1:410 FLEISCHMANN WAY
Mailing Address - Street 2:
Mailing Address - City:CARSON CITY
Mailing Address - State:NV
Mailing Address - Zip Code:89703-2984
Mailing Address - Country:US
Mailing Address - Phone:775-882-3977
Mailing Address - Fax:775-882-3285
Practice Address - Street 1:410 FLEISCHMANN WAY
Practice Address - Street 2:
Practice Address - City:CARSON CITY
Practice Address - State:NV
Practice Address - Zip Code:89703-2984
Practice Address - Country:US
Practice Address - Phone:775-882-3977
Practice Address - Fax:775-882-3285
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-16
Last Update Date:2008-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV200152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NVV105088Medicare PIN
NV0300070001Medicare NSC
NVU12874Medicare UPIN