Provider Demographics
NPI:1255791760
Name:GIRISGEN & KOPOLOW OD, PC
Entity type:Organization
Organization Name:GIRISGEN & KOPOLOW OD, PC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:SEFIR
Authorized Official - Middle Name:
Authorized Official - Last Name:GIRISGEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:702-733-6764
Mailing Address - Street 1:6160 W TROPICANA AVE
Mailing Address - Street 2:STE E4
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89103-4493
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2021 N RAINBOW BLVD
Practice Address - Street 2:STE 100
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89108-7137
Practice Address - Country:US
Practice Address - Phone:702-733-6764
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:GIRISGEN & KOPOLOW OD, PC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2016-02-25
Last Update Date:2016-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Multi-Specialty