Healthcare Provider Details

I. General information

NPI: 1912213125
Provider Name (Legal Business Name): MICHELLE J MCLAUGHLIN OD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/25/2010
Last Update Date: 03/17/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1010 N WASHINGTON ST
JANESVILLE WI
53548-1500
US

IV. Provider business mailing address

1010 N WASHINGTON ST
JANESVILLE WI
53548-1500
US

V. Phone/Fax

Practice location:
  • Phone: 608-741-6794
  • Fax: 608-741-3838
Mailing address:
  • Phone: 608-741-6794
  • Fax: 608-741-3838

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number3189-035
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: