Provider Demographics
NPI:1568624195
Name:LOEHR, JESSICA (OPTOMETRIST)
Entity Type:Individual
Prefix:DR
First Name:JESSICA
Middle Name:
Last Name:LOEHR
Suffix:
Gender:F
Credentials:OPTOMETRIST
Other - Prefix:MRS
Other - First Name:JESSICA
Other - Middle Name:LOEHR
Other - Last Name:RUDOPLPH
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 300
Mailing Address - Street 2:
Mailing Address - City:VICTORIA
Mailing Address - State:MN
Mailing Address - Zip Code:55386
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:952-443-2387
Practice Address - Street 1:715 E 78TH ST
Practice Address - Street 2:
Practice Address - City:BLOOMINGTON
Practice Address - State:MN
Practice Address - Zip Code:55420-1397
Practice Address - Country:US
Practice Address - Phone:952-854-2262
Practice Address - Fax:952-854-5493
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-25
Last Update Date:2013-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN3128152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN398110100Medicaid
410002988OtherMEDICARE