Provider Demographics
NPI:1174812390
Name:WIKMAN, ELIZABETH COPPOLA (OD)
Entity type:Individual
Prefix:DR
First Name:ELIZABETH
Middle Name:COPPOLA
Last Name:WIKMAN
Suffix:
Gender:F
Credentials:OD
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Mailing Address - Street 1:188 BROADWAY
Mailing Address - Street 2:
Mailing Address - City:METHUEN
Mailing Address - State:MA
Mailing Address - Zip Code:01844-3862
Mailing Address - Country:US
Mailing Address - Phone:978-794-1445
Mailing Address - Fax:978-975-5430
Practice Address - Street 1:39 GREEN ST
Practice Address - Street 2:
Practice Address - City:NEWBURYPORT
Practice Address - State:MA
Practice Address - Zip Code:01950-2652
Practice Address - Country:US
Practice Address - Phone:978-465-8761
Practice Address - Fax:978-465-6228
Is Sole Proprietor?:No
Enumeration Date:2011-03-29
Last Update Date:2011-03-29
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MA4746152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist