Provider Demographics
NPI:1508850132
Name:POLTE, LOREN A (OD)
Entity Type:Individual
Prefix:MR
First Name:LOREN
Middle Name:A
Last Name:POLTE
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 1:2920 COLD SPRINGS RD
Mailing Address - Street 2:SUITE B
Mailing Address - City:PLACERVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:95667-4220
Mailing Address - Country:US
Mailing Address - Phone:530-626-7460
Mailing Address - Fax:530-622-0719
Practice Address - Street 1:2920 COLD SPRINGS RD
Practice Address - Street 2:SUITE B
Practice Address - City:PLACERVILLE
Practice Address - State:CA
Practice Address - Zip Code:95667-4220
Practice Address - Country:US
Practice Address - Phone:530-626-7460
Practice Address - Fax:530-622-0719
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-09-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA7556T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CASD0075560Medicaid