Provider Demographics
NPI:1528596566
Name:LOOCK, KATIE L (OD)
Entity Type:Individual
Prefix:MS
First Name:KATIE
Middle Name:L
Last Name:LOOCK
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
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Mailing Address - Street 1:1225 S GRAND BLVD
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63104-1016
Mailing Address - Country:US
Mailing Address - Phone:314-617-2000
Mailing Address - Fax:314-617-3334
Practice Address - Street 1:1225 S GRAND BLVD
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63104-1016
Practice Address - Country:US
Practice Address - Phone:314-977-4010
Practice Address - Fax:314-977-3495
Is Sole Proprietor?:No
Enumeration Date:2017-06-02
Last Update Date:2023-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2017020442152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist