Provider Demographics
NPI:1407984461
Name:LOEPER VISIONCARE INC
Entity Type:Organization
Organization Name:LOEPER VISIONCARE INC
Other - Org Name:LOEPER VISION TEAM
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:C
Authorized Official - Last Name:LOEPER
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:330-725-6655
Mailing Address - Street 1:801 E WASHINGTON ST
Mailing Address - Street 2:SUITE 120
Mailing Address - City:MEDINA
Mailing Address - State:OH
Mailing Address - Zip Code:44256-3335
Mailing Address - Country:US
Mailing Address - Phone:330-725-6655
Mailing Address - Fax:330-722-5544
Practice Address - Street 1:801 E WASHINGTON ST
Practice Address - Street 2:SUITE 120
Practice Address - City:MEDINA
Practice Address - State:OH
Practice Address - Zip Code:44256-3335
Practice Address - Country:US
Practice Address - Phone:330-725-6655
Practice Address - Fax:330-722-5544
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-01
Last Update Date:2012-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH1084600001OtherDMERC #
OH=========5A00OtherANTHEM GROUP #
OH1084600001OtherDMERC #