Provider Demographics
NPI:1194403774
Name:KOUPAL, BRANDON (OD)
Entity type:Individual
Prefix:DR
First Name:BRANDON
Middle Name:
Last Name:KOUPAL
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8300 COMMONWEALTH DRIVE
Mailing Address - Street 2:APT 334
Mailing Address - City:EDEN PRAIRIE
Mailing Address - State:MN
Mailing Address - Zip Code:55344
Mailing Address - Country:US
Mailing Address - Phone:605-261-6327
Mailing Address - Fax:
Practice Address - Street 1:1004 COUNTY ROAD 42 E
Practice Address - Street 2:
Practice Address - City:BURNSVILLE
Practice Address - State:MN
Practice Address - Zip Code:55337-4652
Practice Address - Country:US
Practice Address - Phone:952-894-1400
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-07-05
Last Update Date:2023-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN3874152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist