Provider Demographics
NPI:1548374572
Name:KOEPSELL, DON G (MD PHD)
Entity type:Individual
Prefix:
First Name:DON
Middle Name:G
Last Name:KOEPSELL
Suffix:
Gender:M
Credentials:MD PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1220 VALLEY FORGE RD SUITE 39
Mailing Address - Street 2:PO BOX 608
Mailing Address - City:VALLEY FORGE
Mailing Address - State:PA
Mailing Address - Zip Code:19482-0608
Mailing Address - Country:US
Mailing Address - Phone:610-935-1211
Mailing Address - Fax:610-935-2355
Practice Address - Street 1:1220 VALLEY FORGE RD
Practice Address - Street 2:SUITE 39
Practice Address - City:VALLEY FORGE
Practice Address - State:PA
Practice Address - Zip Code:19482-0608
Practice Address - Country:US
Practice Address - Phone:610-935-1211
Practice Address - Fax:610-935-2355
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-18
Last Update Date:2008-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD024428E207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
000103038OtherBLUE SHIELD
PA0008690260003Medicaid
0053163000OtherINDEPENDENCE BLUE CROSS
180007899Medicare PIN
000103038OtherBLUE SHIELD
B36491Medicare UPIN