Provider Demographics
NPI:1669526893
Name:KOPERWAS, ERIC STUART (OD)
Entity type:Individual
Prefix:
First Name:ERIC
Middle Name:STUART
Last Name:KOPERWAS
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 1:156 W 28TH ST
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10001-6125
Mailing Address - Country:US
Mailing Address - Phone:212-244-5536
Mailing Address - Fax:
Practice Address - Street 1:156 W 28TH ST
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10001-6125
Practice Address - Country:US
Practice Address - Phone:212-244-5536
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-23
Last Update Date:2008-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYTUV003761152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYU17997Medicare UPIN
NYC4108YPXV1Medicare PIN