Individual
HOLLY RAEANN KOOPMAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
OD
Contact information
Practice address
6812 DIXIE HWY, LOUISVILLE, KY 40258-3914
(502) 933-7986
(502) 933-2652
Mailing address
4000 POPLAR LEVEL RD, LOUISVILLE, KY 40213-1524
(502) 813-8928
(502) 456-9121
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
18004061A
IN
152W00000X
Optometrist
Primary
2017DT
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
18004061A
INDIANA LICENSE NUMBER
IN
01
—
2017DT
KENTUCKY LIENSE
KY
01
—
221390002
INDIANA MEDICARE
IN
05
—
7100492340
—
KY
01
—
K249890
KENTUCKY MEDICARE
KY
05
—
PENDING
—
IN
Enumeration date
06/15/2016
Last updated
06/11/2019
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