Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207W00000X | Ophthalmologist | 45451 | WI |
NPI | 1013983584 |
---|---|
Provider Name | Heather Ad Potter |
First Address | Middleton, WI 53562-5531 |
Second Address | Madison, WI 53705 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 24/02/2006 |
Last Update Date | 22/01/2021 |