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General NPI Number Information
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NPI Number | 1336385574
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Entity Type | Organization
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Legal Business Name | ROBERT KOPPANY
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Dates
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Enumeration Date | 12/17/2008
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Last Update Date | 12/17/2008
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Provider Practice Location Address
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Address Line | 15908 BEAR VALLEY RD # A
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City | VICTORVILLE
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State | CA
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Zip | 92395-9547
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Country | US
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Telephone | 760-243-4559
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Fax | 760-243-2052
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Provider Business Mailing Address
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Address Line | 15908 BEAR VALLEY RD # A
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City | VICTORVILLE
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State | CA
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Zip | 92395-9547
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Country | US
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Telephone | 760-243-4559
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Fax | 760-243-2052
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Authorized Official
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Title or Position | OPTOMETRIST, OWNER
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Name | DR. ROBERT KOPPANY
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Credential | O.D.
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Telephone | 760-243-4559
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number | 8523TG
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License Number State | CA
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