Provider Demographics
NPI:1649241399
Name:LOFLIN, KEVIN (OD)
Entity Type:Individual
Prefix:DR
First Name:KEVIN
Middle Name:
Last Name:LOFLIN
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 1:817 E GANNON AVE STE 101
Mailing Address - Street 2:
Mailing Address - City:ZEBULON
Mailing Address - State:NC
Mailing Address - Zip Code:27597-8940
Mailing Address - Country:US
Mailing Address - Phone:919-269-9700
Mailing Address - Fax:
Practice Address - Street 1:817 E GANNON AVE
Practice Address - Street 2:SUITE 101
Practice Address - City:ZEBULON
Practice Address - State:NC
Practice Address - Zip Code:27597-9309
Practice Address - Country:US
Practice Address - Phone:919-269-9700
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-01-31
Last Update Date:2017-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC1684152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC890916RMedicaid
NC0916ROtherBCBSNC PIN
NC890916RMedicaid
NC410047172Medicare PIN
NC2470922AMedicare PIN