Provider Demographics
NPI:1083313100
Name:LOOMIS, JULIA A (OPTICIAN)
Entity Type:Individual
Prefix:
First Name:JULIA
Middle Name:A
Last Name:LOOMIS
Suffix:
Gender:F
Credentials:OPTICIAN
Other - Prefix:MS
Other - First Name:JULIA
Other - Middle Name:A
Other - Last Name:LOOMIS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:OPTICIAN
Mailing Address - Street 1:6244 WILMINGTON PIKE
Mailing Address - Street 2:
Mailing Address - City:CENTERVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:45459-7024
Mailing Address - Country:US
Mailing Address - Phone:937-848-2243
Mailing Address - Fax:937-848-2498
Practice Address - Street 1:6244 WILMINGTON PIKE
Practice Address - Street 2:
Practice Address - City:CENTERVILLE
Practice Address - State:OH
Practice Address - Zip Code:45459-7024
Practice Address - Country:US
Practice Address - Phone:937-848-2243
Practice Address - Fax:937-848-2498
Is Sole Proprietor?:Yes
Enumeration Date:2023-02-27
Last Update Date:2023-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH4838-S156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician