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General NPI Number Information
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NPI Number | 1336463363
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Entity Type | Organization
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Legal Business Name | STANLEY M KOPELOW M D INC
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Dates
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Enumeration Date | 03/19/2010
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Last Update Date | 03/31/2022
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Provider Practice Location Address
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Address Line | 16311 VENTURA BLVD SUITE # 750
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City | ENCINO
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State | CA
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Zip | 91436-4325
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Country | US
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Telephone | 818-990-3623
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Fax | 818-788-1056
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Provider Business Mailing Address
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Address Line | 16311 VENTURA BLVD SUITE # 750
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City | ENCINO
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State | CA
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Zip | 91436-4325
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Country | US
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Telephone | 818-990-3623
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Fax | 818-788-1056
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Authorized Official
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Title or Position | OWNER
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Name | DR. STANLEY MARTIN KOLELOW
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Credential | M D
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Telephone | 818-990-3623
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207W00000X
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Taxonomy Name | Ophthalmology Physician
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License Number | G14728
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License Number State | CA
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