Provider Demographics
NPI:1215918602
Name:KOPELOW, STANLEY M (MD)
Entity type:Individual
Prefix:DR
First Name:STANLEY
Middle Name:M
Last Name:KOPELOW
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16311 VENTURA BLVD
Mailing Address - Street 2:SUITE 750
Mailing Address - City:ENCINO
Mailing Address - State:CA
Mailing Address - Zip Code:91436-2124
Mailing Address - Country:US
Mailing Address - Phone:818-990-3623
Mailing Address - Fax:818-788-1056
Practice Address - Street 1:16311 VENTURA BLVD
Practice Address - Street 2:SUITE 750
Practice Address - City:ENCINO
Practice Address - State:CA
Practice Address - Zip Code:91436-2124
Practice Address - Country:US
Practice Address - Phone:818-990-3623
Practice Address - Fax:818-788-1056
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-11
Last Update Date:2022-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG14728207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA39322Medicare UPIN