Provider Demographics
NPI:1902034259
Name:KOPANI, KAMDEN
Entity Type:Individual
Prefix:DR
First Name:KAMDEN
Middle Name:
Last Name:KOPANI
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:800 WASHINGTON ST
Mailing Address - Street 2:BOX 450
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02111-1552
Mailing Address - Country:US
Mailing Address - Phone:617-636-0626
Mailing Address - Fax:617-636-4866
Practice Address - Street 1:800 WASHINGTON ST
Practice Address - Street 2:BOX 450
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02111-1552
Practice Address - Country:US
Practice Address - Phone:617-636-0626
Practice Address - Fax:617-636-4866
Is Sole Proprietor?:Yes
Enumeration Date:2009-06-25
Last Update Date:2015-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA254753207W00000X, 207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology