Healthcare Provider Details

I. General information

NPI: 1881735439
Provider Name (Legal Business Name): KOPOLOW & GIRISGEN PROFESSIONAL CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/08/2007
Last Update Date: 05/06/2020
Certification Date: 05/06/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3200 LAS VEGAS BLVD S STE 1620
LAS VEGAS NV
89109-0739
US

IV. Provider business mailing address

3200 LAS VEGAS BLVD S STE 1620
LAS VEGAS NV
89109-0739
US

V. Phone/Fax

Practice location:
  • Phone: 702-341-7254
  • Fax: 702-731-6120
Mailing address:
  • Phone: 702-341-7254
  • Fax: 702-731-6120

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number
License Number State

VIII. Authorized Official

Name: DR. STEVE T GIRISGEN
Title or Position: PRESIDENT
Credential: O.D.
Phone: 702-341-7254