Provider Demographics
NPI:1912213125
Name:MCLAUGHLIN, MICHELLE J (OD)
Entity Type:Individual
Prefix:
First Name:MICHELLE
Middle Name:J
Last Name:MCLAUGHLIN
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 1:1010 N WASHINGTON ST
Mailing Address - Street 2:
Mailing Address - City:JANESVILLE
Mailing Address - State:WI
Mailing Address - Zip Code:53548-1500
Mailing Address - Country:US
Mailing Address - Phone:608-741-6794
Mailing Address - Fax:608-741-3838
Practice Address - Street 1:1010 N WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:JANESVILLE
Practice Address - State:WI
Practice Address - Zip Code:53548-1500
Practice Address - Country:US
Practice Address - Phone:608-741-6794
Practice Address - Fax:608-741-3838
Is Sole Proprietor?:No
Enumeration Date:2010-08-25
Last Update Date:2014-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI3189-035152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI1912213125OtherBCBSWI
WI1912213125Medicaid
WIMCLAUMICOtherMERCYCARE INSURANCE
WIMCLAUMICOtherMERCYCARE INSURANCE
WI1912213125OtherBCBSWI