Provider Demographics
NPI:1477275436
Name:PAULSON, LAURA NICOLE (OD)
Entity Type:Individual
Prefix:MS
First Name:LAURA
Middle Name:NICOLE
Last Name:PAULSON
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:311 COPPERFIELD DR
Mailing Address - Street 2:
Mailing Address - City:DELAFIELD
Mailing Address - State:WI
Mailing Address - Zip Code:53018-1155
Mailing Address - Country:US
Mailing Address - Phone:262-312-0169
Mailing Address - Fax:
Practice Address - Street 1:950 W CLAIREMONT AVE
Practice Address - Street 2:
Practice Address - City:EAU CLAIRE
Practice Address - State:WI
Practice Address - Zip Code:54701-6192
Practice Address - Country:US
Practice Address - Phone:715-834-8471
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-09-16
Last Update Date:2023-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI0000000000152W00000X
390200000X
WI3866-35152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program