Provider Demographics
NPI:1790149003
Name:COUDRON, LAURA (OD)
Entity Type:Individual
Prefix:DR
First Name:LAURA
Middle Name:
Last Name:COUDRON
Suffix:
Gender:F
Credentials:OD
Other - Prefix:DR
Other - First Name:LAURA
Other - Middle Name:KAY
Other - Last Name:GOEMANN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OD
Mailing Address - Street 1:111 STAR ST STE 101
Mailing Address - Street 2:
Mailing Address - City:MANKATO
Mailing Address - State:MN
Mailing Address - Zip Code:56001-4889
Mailing Address - Country:US
Mailing Address - Phone:507-387-6695
Mailing Address - Fax:507-387-6696
Practice Address - Street 1:111 STAR ST STE 101
Practice Address - Street 2:
Practice Address - City:MANKATO
Practice Address - State:MN
Practice Address - Zip Code:56001-4889
Practice Address - Country:US
Practice Address - Phone:507-387-6695
Practice Address - Fax:507-387-6696
Is Sole Proprietor?:Yes
Enumeration Date:2016-04-12
Last Update Date:2023-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN3520152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist