Provider Demographics
NPI:1780065771
Name:PURDUE, LAURA (OD)
Entity type:Individual
Prefix:DR
First Name:LAURA
Middle Name:
Last Name:PURDUE
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:LAURA
Other - Middle Name:
Other - Last Name:ZINK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OD
Mailing Address - Street 1:1350 E HICKMAN RD
Mailing Address - Street 2:
Mailing Address - City:WAUKEE
Mailing Address - State:IA
Mailing Address - Zip Code:50263-8137
Mailing Address - Country:US
Mailing Address - Phone:515-221-9195
Mailing Address - Fax:
Practice Address - Street 1:1350 E HICKMAN RD
Practice Address - Street 2:
Practice Address - City:WAUKEE
Practice Address - State:IA
Practice Address - Zip Code:50263-8137
Practice Address - Country:US
Practice Address - Phone:515-221-9195
Practice Address - Fax:515-221-9196
Is Sole Proprietor?:No
Enumeration Date:2015-06-15
Last Update Date:2019-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX8698T152W00000X
FLOPC5188152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist