Provider Demographics
NPI:1528035110
Name:LOUDENSLAGER, WILLIAM C (OD)
Entity Type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:C
Last Name:LOUDENSLAGER
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 1:5164 CHILDRENS HOME RD
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:45331-9327
Mailing Address - Country:US
Mailing Address - Phone:937-548-7811
Mailing Address - Fax:937-547-0672
Practice Address - Street 1:5164 CHILDRENS HOME RD
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:OH
Practice Address - Zip Code:45331-9327
Practice Address - Country:US
Practice Address - Phone:937-548-7811
Practice Address - Fax:937-547-0672
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-03-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH2709/T1249152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0726870001OtherDMERC SUPPLIER
OH5292884Medicaid
OH0726870001OtherDMERC SUPPLIER
OHLO0157583Medicare ID - Type Unspecified