Provider Demographics
NPI:1679681829
Name:LOOMIS, FRANCIS M II
Entity Type:Individual
Prefix:DR
First Name:FRANCIS
Middle Name:M
Last Name:LOOMIS
Suffix:II
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:550 30TH AVE
Mailing Address - Street 2:STE #1
Mailing Address - City:MOLINE
Mailing Address - State:IL
Mailing Address - Zip Code:61265-5975
Mailing Address - Country:US
Mailing Address - Phone:309-764-2623
Mailing Address - Fax:309-764-5214
Practice Address - Street 1:550 30TH AVE
Practice Address - Street 2:STE #1
Practice Address - City:MOLINE
Practice Address - State:IL
Practice Address - Zip Code:61265-5975
Practice Address - Country:US
Practice Address - Phone:309-764-2623
Practice Address - Fax:309-764-5214
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-28
Last Update Date:2017-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL046-006416152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILT39160Medicare UPIN
IL0489920001Medicare NSC
IL215960Medicare PIN