Provider Demographics
NPI:1841276979
Name:KOPP, STEVE J (OD PC)
Entity type:Individual
Prefix:MR
First Name:STEVE
Middle Name:J
Last Name:KOPP
Suffix:
Gender:M
Credentials:OD PC
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Mailing Address - Street 1:2820 N GLASSFORD HILL RD
Mailing Address - Street 2:
Mailing Address - City:PRESCOTT VALLEY
Mailing Address - State:AZ
Mailing Address - Zip Code:86314-1242
Mailing Address - Country:US
Mailing Address - Phone:844-565-6393
Mailing Address - Fax:844-329-5656
Practice Address - Street 1:40 CAPRI BLVD STE 102
Practice Address - Street 2:
Practice Address - City:LAKE HAVASU CITY
Practice Address - State:AZ
Practice Address - Zip Code:86403-5661
Practice Address - Country:US
Practice Address - Phone:602-955-1000
Practice Address - Fax:602-508-4830
Is Sole Proprietor?:No
Enumeration Date:2005-12-20
Last Update Date:2020-05-21
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
AZOPT-001732152W00000X
OR2340AT152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
ORR102315Medicare ID - Type UnspecifiedPROVIDER ID #