MEDICARE: H KENNETH KOPOLOW O.D & ASSOC P.C

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	152W00000X	Optometrist	274	NV

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1336186444
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	H KENNETH KOPOLOW O.D & ASSOC P.C

Provider Business Mailing Address
First Line	:	7361 W LAKE MEAD BLVD
Second Line	:	STE 104
City	:	LAS VEGAS
State	:	NV
Zip	:	89128-1040
Country	:	US
Telephone Number	:	702-733-6764
Fax Number	:	702-255-5797

Provider Business Practice Location Address
First Line	:	4300 MEADOWS LN
Second Line	:	STE 126
City	:	LAS VEGAS
State	:	NV
Zip	:	89107-3004
Country	:	US
Telephone Number	:	702-733-6764
Fax Number	:	702-614-6018

Authorized Official
Title or Position	:	PRESIDENT
Name	:	HARLAN KENNETH KOPOLOW
Credential	:	O.D
Telephone Number	:	702-733-6764

Provider Enumeration Date	:	05/31/2006
Last Update Date	:	09/16/2009

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