Healthcare Provider Details

I. General information

NPI: 1952487514
Provider Name (Legal Business Name): DEAN KOPAN O.D,
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/27/2006
Last Update Date: 09/09/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4021 W SYLVANIA AVE
TOLEDO OH
43623-4428
US

IV. Provider business mailing address

4021 W SYLVANIA AVE
TOLEDO OH
43623-4428
US

V. Phone/Fax

Practice location:
  • Phone: 419-475-6181
  • Fax: 419-475-5720
Mailing address:
  • Phone: 419-475-6181
  • Fax: 419-475-5720

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number4117 T68
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: