Provider Demographics
NPI:1982964730
Name:KOPCZYK, AMANDA LYNN (OD)
Entity type:Individual
Prefix:DR
First Name:AMANDA
Middle Name:LYNN
Last Name:KOPCZYK
Suffix:
Gender:F
Credentials:OD
Other - Prefix:DR
Other - First Name:AMANDA
Other - Middle Name:LYNN
Other - Last Name:LEONHARD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OD
Mailing Address - Street 1:16800 W CLEVELAND AVE
Mailing Address - Street 2:
Mailing Address - City:NEW BERLIN
Mailing Address - State:WI
Mailing Address - Zip Code:53151-3533
Mailing Address - Country:US
Mailing Address - Phone:262-923-7298
Mailing Address - Fax:262-923-7299
Practice Address - Street 1:12876 W BLUEMOUND RD
Practice Address - Street 2:
Practice Address - City:ELM GROVE
Practice Address - State:WI
Practice Address - Zip Code:53122-2605
Practice Address - Country:US
Practice Address - Phone:262-432-0052
Practice Address - Fax:262-923-7610
Is Sole Proprietor?:No
Enumeration Date:2012-05-25
Last Update Date:2014-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI152W00000X152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist