Provider Demographics
NPI:1568422301
Name:LOOMIS, TROY D (OD)
Entity Type:Individual
Prefix:DR
First Name:TROY
Middle Name:D
Last Name:LOOMIS
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:6099 WAYZATA BLVD STE 120
Mailing Address - Street 2:
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55416-5538
Mailing Address - Country:US
Mailing Address - Phone:952-204-5060
Mailing Address - Fax:952-204-9060
Practice Address - Street 1:6099 WAYZATA BLVD STE 120
Practice Address - Street 2:
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55416-5538
Practice Address - Country:US
Practice Address - Phone:952-204-5060
Practice Address - Fax:952-204-9060
Is Sole Proprietor?:No
Enumeration Date:2006-03-24
Last Update Date:2022-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN2691152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN447819300Medicaid
MN447819300Medicaid
MNU77513Medicare UPIN