Provider Demographics
NPI:1043230675
Name:LOUGHMAN, STEPHEN PAUL (OD)
Entity Type:Individual
Prefix:
First Name:STEPHEN
Middle Name:PAUL
Last Name:LOUGHMAN
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 1:9238 WOODSTONE ST
Mailing Address - Street 2:
Mailing Address - City:LENEXA
Mailing Address - State:KS
Mailing Address - Zip Code:66219-1958
Mailing Address - Country:US
Mailing Address - Phone:913-495-9999
Mailing Address - Fax:913-307-0535
Practice Address - Street 1:9238 WOODSTONE ST
Practice Address - Street 2:
Practice Address - City:LENEXA
Practice Address - State:KS
Practice Address - Zip Code:66219-1958
Practice Address - Country:US
Practice Address - Phone:913-495-9999
Practice Address - Fax:913-307-0535
Is Sole Proprietor?:No
Enumeration Date:2006-07-19
Last Update Date:2015-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOT02949152W00000X
KS1311152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PO1389873OtherMCR RR
KS100219730BMedicaid
MOMA5027001Medicare PIN
KS100219730BMedicaid
1043230675Medicare UPIN
0480010002Medicare NSC
MOMA5026001Medicare PIN
MO0002589Medicare ID - Type UnspecifiedIND #
U16657Medicare UPIN