Provider Demographics
NPI:1801053012
Name:STEVEN J KOPP OD PC
Entity type:Organization
Organization Name:STEVEN J KOPP OD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:TINA
Authorized Official - Middle Name:L
Authorized Official - Last Name:KOPP
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:541-389-3329
Mailing Address - Street 1:63455 N HIGHWAY 97
Mailing Address - Street 2:SUITE 75
Mailing Address - City:BEND
Mailing Address - State:OR
Mailing Address - Zip Code:97701-6764
Mailing Address - Country:US
Mailing Address - Phone:541-389-3329
Mailing Address - Fax:541-318-3390
Practice Address - Street 1:63455 N HIGHWAY 97
Practice Address - Street 2:SUITE 75
Practice Address - City:BEND
Practice Address - State:OR
Practice Address - Zip Code:97701-6764
Practice Address - Country:US
Practice Address - Phone:541-389-3329
Practice Address - Fax:541-318-3390
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-16
Last Update Date:2008-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR2340ATL305R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes305R00000XManaged Care OrganizationsPreferred Provider Organization