Provider Demographics
NPI:1649412834
Name:DAVID A LOTZ, OPTOMETRIST, PC
Entity Type:Organization
Organization Name:DAVID A LOTZ, OPTOMETRIST, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:A
Authorized Official - Last Name:LOTZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:757-539-8716
Mailing Address - Street 1:1238 HOLLAND RD
Mailing Address - Street 2:SUITE 103
Mailing Address - City:SUFFOLK
Mailing Address - State:VA
Mailing Address - Zip Code:23434-6300
Mailing Address - Country:US
Mailing Address - Phone:757-539-8716
Mailing Address - Fax:757-539-7166
Practice Address - Street 1:1238 HOLLAND RD
Practice Address - Street 2:SUITE 103
Practice Address - City:SUFFOLK
Practice Address - State:VA
Practice Address - Zip Code:23434-6300
Practice Address - Country:US
Practice Address - Phone:757-539-8716
Practice Address - Fax:757-539-7166
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-04-02
Last Update Date:2014-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0618000298152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
250387OtherANTHEM BCBS OF VIRGINIA
VA9230271Medicaid
VA9230271Medicaid