Provider Demographics
NPI:1881752095
Name:DOCTORS KIME KOPAN ASSOCIATES
Entity type:Organization
Organization Name:DOCTORS KIME KOPAN ASSOCIATES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ACCOUNTS MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:LINDA
Authorized Official - Middle Name:M
Authorized Official - Last Name:BORRELL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:419-475-6181
Mailing Address - Street 1:4021 W SYLVANIA AVE
Mailing Address - Street 2:
Mailing Address - City:TOLEDO
Mailing Address - State:OH
Mailing Address - Zip Code:43623-4428
Mailing Address - Country:US
Mailing Address - Phone:419-475-6181
Mailing Address - Fax:419-475-5720
Practice Address - Street 1:4021 W SYLVANIA AVE
Practice Address - Street 2:
Practice Address - City:TOLEDO
Practice Address - State:OH
Practice Address - Zip Code:43623-4428
Practice Address - Country:US
Practice Address - Phone:419-475-6181
Practice Address - Fax:419-475-5720
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-04
Last Update Date:2015-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH2690T513152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0854286Medicaid
OH0429900001Medicare NSC
OHMEDICARE ID 9328471Medicare PIN