Healthcare Provider Details

I. General information

NPI: 1033614755
Provider Name (Legal Business Name): KOPOLOW & GIRISGEN PROFESSIONAL CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/26/2018
Last Update Date: 05/06/2020
Certification Date: 05/06/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13921 S VIRGINIA ST STE 116
RENO NV
89511-2911
US

IV. Provider business mailing address

4045 SPENCER ST STE A59
LAS VEGAS NV
89119-9311
US

V. Phone/Fax

Practice location:
  • Phone: 702-341-7254
  • Fax:
Mailing address:
  • Phone: 702-733-6764
  • Fax: 702-255-5795

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: STEVE T GIRISGEN
Title or Position: OWNER
Credential:
Phone: 702-275-5229