MEDICARE: GIRISGEN & KOPOLOW OD PC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	152W00000X	Optometrist

General Provider Information

NPI Number	:	1063034379
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GIRISGEN & KOPOLOW OD PC

Provider Business Mailing Address
First Line	:	4045 SPENCER ST STE A59
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89119-9311
Country	:	US
Telephone Number	:	702-437-5521
Fax Number	:	702-437-5502

Provider Business Practice Location Address
First Line	:	9770 S MARYLAND PKWY STE 10
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89183-7143
Country	:	US
Telephone Number	:	702-452-2020
Fax Number	:	702-437-5502

Authorized Official
Title or Position	:	OPTOMETRIST/CO-OWNER
Name	:	DR. STEVE T GIRISGEN
Credential	:
Telephone Number	:	702-437-5521

Provider Enumeration Date	:	05/08/2020
Last Update Date	:	05/08/2020

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