Provider Demographics
NPI:1851369151
Name:KOPIETZ, LESLIE A (MD)
Entity Type:Individual
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First Name:LESLIE
Middle Name:A
Last Name:KOPIETZ
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Gender:F
Credentials:MD
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Mailing Address - Street 1:8100 34TH AVE S
Mailing Address - Street 2:21110Q
Mailing Address - City:BLOOMINGTON
Mailing Address - State:MN
Mailing Address - Zip Code:55425-1672
Mailing Address - Country:US
Mailing Address - Phone:952-883-5790
Mailing Address - Fax:952-883-5395
Practice Address - Street 1:401 PHALEN BLVD
Practice Address - Street 2:MAIL STOP 41102E
Practice Address - City:ST PAUL
Practice Address - State:MN
Practice Address - Zip Code:55101-5302
Practice Address - Country:US
Practice Address - Phone:651-254-7500
Practice Address - Fax:651-254-7557
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-03-10
Last Update Date:2007-07-08
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Provider Licenses
StateLicense IDTaxonomies
MN27614207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
D81803Medicare UPIN