MEDICARE: JILL KOPECHEK OD

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	OPT.006752	OH

General Provider Information

NPI Number	:	1861044125
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JILL KOPECHEK OD

Provider Business Mailing Address
First Line	:	7727 STRAWBERRY FLDS
Second Line	:
City	:	COLUMBUS
State	:	OH
Zip	:	43235-8955
Country	:	US
Telephone Number	:	937-409-5531
Fax Number	:

Provider Business Practice Location Address
First Line	:	1558 COSHOCTON AVE
Second Line	:
City	:	MOUNT VERNON
State	:	OH
Zip	:	43050-5416
Country	:	US
Telephone Number	:	937-409-5531
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/16/2019
Last Update Date	:	07/16/2019

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