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General NPI Number Information
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NPI Number | 1932220324
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Entity Type | Organization
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Legal Business Name | K J KOPECKO O D CHRISTINE L MAYER O D OPTOMETRY CORP
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Dates
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Enumeration Date | 04/03/2007
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Last Update Date | 01/29/2013
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Provider Practice Location Address
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Address Line | 2581 NUT TREE RD SUITE C
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City | VACAVILLE
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State | CA
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Zip | 95687-6915
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Country | US
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Telephone | 707-447-1332
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Fax |
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Provider Business Mailing Address
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Address Line | 2581 NUT TREE RD SUITE C
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City | VACAVILLE
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State | CA
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Zip | 95687-6915
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Country | US
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Telephone | 707-447-1332
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Fax |
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Authorized Official
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Title or Position | CFO
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Name | CHRISTINE LOUISE MAYER
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Credential |
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Telephone | 707-447-1332
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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 | 7004
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License Number State | CA
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