Provider Demographics
NPI:1457716391
Name:GIRISGEN & KOPOLOW OD, PC
Entity Type:Organization
Organization Name:GIRISGEN & KOPOLOW OD, PC
Other - Org Name:PEARLE VISION NELLIS
Other - Org Type:Doing Business As
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 1:230 N NELLIS BLVD
Mailing Address - Street 2:STE B
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89110-6002
Mailing Address - Country:US
Mailing Address - Phone:702-452-2020
Mailing Address - Fax:702-255-5795
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:702-255-5795
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:GIRISGEN & KOPOLOW OD, PC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2015-12-18
Last Update Date:2015-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Multi-Specialty