Provider Demographics
NPI:1013994524
Name:RAU, LAURA J (OD)
Entity Type:Individual
Prefix:
First Name:LAURA
Middle Name:J
Last Name:RAU
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 1:24 DENEVEU CIR
Mailing Address - Street 2:
Mailing Address - City:FOND DU LAC
Mailing Address - State:WI
Mailing Address - Zip Code:54935-5457
Mailing Address - Country:US
Mailing Address - Phone:920-924-9585
Mailing Address - Fax:
Practice Address - Street 1:24 DENEVEU CIR
Practice Address - Street 2:
Practice Address - City:FOND DU LAC
Practice Address - State:WI
Practice Address - Zip Code:54935-5457
Practice Address - Country:US
Practice Address - Phone:920-924-9585
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-12-27
Last Update Date:2016-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI2026152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist