Provider Demographics
NPI:1710946991
Name:LOPATIN, BRIAN D (OD)
Entity Type:Individual
Prefix:DR
First Name:BRIAN
Middle Name:D
Last Name:LOPATIN
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 1:211 E BROADWAY
Mailing Address - Street 2:
Mailing Address - City:ALTON
Mailing Address - State:IL
Mailing Address - Zip Code:62002-6220
Mailing Address - Country:US
Mailing Address - Phone:314-533-1898
Mailing Address - Fax:800-432-6004
Practice Address - Street 1:4145 LINDELL BLVD
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63108-2913
Practice Address - Country:US
Practice Address - Phone:314-533-1898
Practice Address - Fax:800-432-6004
Is Sole Proprietor?:No
Enumeration Date:2006-03-17
Last Update Date:2012-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOT03191152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO315083105Medicaid
MOP00403024OtherRR MEDICARE
115889OtherBLUE CROSS BLUE SHIELD MO
23056OtherOPTICARE MED. COMPLETE
IL410048354OtherRR MEDICARE
PENDINGOtherGROUP HEALTH PLAN
MO3191OtherEYEMED
21176OtherHEALTHCARE
UNKNOWNOtherDAVIS VISION
22-00106OtherUNITED HEALTHCARE
115889OtherBLUE CHOICE
674835OtherHEALTHLINK
U89401OtherMERCY HEALTH PLANS
UNKNOWNOtherVISION CARE PLAN
UNKNOWNOtherDAVIS VISION
MO3191OtherEYEMED
MO000093156Medicare PIN