Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207W00000X | Ophthalmologist | 66019 | WI |
N | 207W00000X | Ophthalmologist | MD171856 | OR |
NPI | 1003106378 |
---|---|
Provider Name | Laura Jean Kopplin |
First Address | Middleton, WI 53562-5531 |
Second Address | Madison, WI 53792 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 07/04/2011 |
Last Update Date | 15/01/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1003106378 | (05) | WI |