Individual
DR. MICHAEL ADAM KOEPPE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
O.D.
Contact information
Practice address
3232 13TH AVE S, FARGO, ND 58103
(701) 280-3000
(701) 280-1304
Mailing address
3232 13TH AVE S, FARGO, ND 58103
(701) 280-3000
(701) 280-1304
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
682
ND
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
N714659
MEDICARE PTAN
ND
Enumeration date
07/19/2009
Last updated
09/30/2013
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