Provider Demographics
NPI:1659378677
Name:LOFTUS, KENNETH ALAN (OD)
Entity Type:Individual
Prefix:DR
First Name:KENNETH
Middle Name:ALAN
Last Name:LOFTUS
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 1:450 SISKIYOU BLVD
Mailing Address - Street 2:STE 2
Mailing Address - City:ASHLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97520-5107
Mailing Address - Country:US
Mailing Address - Phone:541-482-3873
Mailing Address - Fax:541-482-9115
Practice Address - Street 1:450 SISKIYOU BLVD
Practice Address - Street 2:STE 2
Practice Address - City:ASHLAND
Practice Address - State:OR
Practice Address - Zip Code:97520-5107
Practice Address - Country:US
Practice Address - Phone:541-482-3873
Practice Address - Fax:541-482-9115
Is Sole Proprietor?:No
Enumeration Date:2005-07-05
Last Update Date:2010-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR2634ATI152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR298558Medicaid
ORR152537Medicare PIN
U96436Medicare UPIN
ORR152536Medicare PIN
OR298558Medicaid
OR5716220001Medicare NSC