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General NPI Number Information
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NPI Number | 1407987001
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Entity Type | Organization
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Legal Business Name | LONE TREE OPTOMETRY, INC.
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Dates
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Enumeration Date | 03/08/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 5113 LONE TREE WY
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City | ANTIOCH
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State | CA
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Zip | 94531-8484
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Country | US
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Telephone | 925-778-1505
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Fax | 925-778-1648
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Provider Business Mailing Address
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Address Line | 5113 LONE TREE WY
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City | ANTIOCH
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State | CA
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Zip | 94531-8484
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Country | US
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Telephone | 925-778-1505
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Fax | 925-778-1648
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Authorized Official
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Title or Position | PARTNER
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Name | DR. KAREN KOPIKO
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Credential | O.D.
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Telephone | 925-778-1505
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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 | 11256T
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number | 11938T
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License Number State | CA
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Taxonomy #3
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number | 11228T
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License Number State | CA
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