Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 152W00000X | Optometrist | 200 | NV |
NPI | 1013068048 |
---|---|
Provider Name | Dr. Katrina Copoulos |
First Address | Carson City, NV 89703-2984 |
Second Address | Carson City, NV 89703-2984 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 16/01/2007 |
Last Update Date | 21/02/2008 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
U12874 | (02) | NV |