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General NPI Number Information
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NPI Number | 1487890695
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Entity Type | Organization
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Legal Business Name | ROBERT KOPPANY, OD, A PROFESSIONAL CORP.
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Dates
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Enumeration Date | 12/18/2008
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Last Update Date | 01/07/2016
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Provider Practice Location Address
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Address Line | 4840 W 123RD ST
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City | HAWTHORNE
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State | CA
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Zip | 90250-3514
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Country | US
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Telephone | 310-679-5604
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Fax | 310-644-6796
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Provider Business Mailing Address
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Address Line | 4840 W 123RD ST
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City | HAWTHORNE
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State | CA
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Zip | 90250-3514
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Country | US
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Telephone | 310-679-5604
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Fax | 310-644-6796
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Authorized Official
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Title or Position | OPTOMETRIST
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Name | DR. ROBERT J KOPPANY
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Credential | O.D.
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Telephone | 310-679-5604
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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 | 8523TPG
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License Number State | CA
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