Provider Demographics
NPI:1588646822
Name:LOOMIS, ZOEY KAY (OD)
Entity Type:Individual
Prefix:DR
First Name:ZOEY
Middle Name:KAY
Last Name:LOOMIS
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:231 PROSPECT ST
Mailing Address - Street 2:SUITE B
Mailing Address - City:FORT MORGAN
Mailing Address - State:CO
Mailing Address - Zip Code:80701-3161
Mailing Address - Country:US
Mailing Address - Phone:970-867-3937
Mailing Address - Fax:970-867-3037
Practice Address - Street 1:231 PROSPECT ST
Practice Address - Street 2:SUITE B
Practice Address - City:FORT MORGAN
Practice Address - State:CO
Practice Address - Zip Code:80701-3161
Practice Address - Country:US
Practice Address - Phone:970-867-3937
Practice Address - Fax:970-867-3037
Is Sole Proprietor?:No
Enumeration Date:2005-11-14
Last Update Date:2009-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COOPT 1825152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO410048482OtherRAILROAD MEDICARE
CO64656276Medicaid
462990Medicare UPIN
CO410048482OtherRAILROAD MEDICARE