Provider Demographics
NPI:1710970256
Name:LOY, JEREMY E (OD)
Entity Type:Individual
Prefix:DR
First Name:JEREMY
Middle Name:E
Last Name:LOY
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
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Mailing Address - Street 1:1101 W ROSEDALE ST
Mailing Address - Street 2:SUITE A
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76104-4425
Mailing Address - Country:US
Mailing Address - Phone:817-885-7951
Mailing Address - Fax:817-885-7953
Practice Address - Street 1:1101 W ROSEDALE ST
Practice Address - Street 2:SUITE A
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76104-4425
Practice Address - Country:US
Practice Address - Phone:817-885-7951
Practice Address - Fax:817-885-7953
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-30
Last Update Date:2019-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX6992TG152WC0802X, 152WL0500X, 152WP0200X, 152WS0006X, 152WV0400X, 152WX0102X, 152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Multi-Specialty
No152WC0802XEye and Vision Services ProvidersOptometristCorneal and Contact ManagementGroup - Multi-Specialty
No152WL0500XEye and Vision Services ProvidersOptometristLow Vision RehabilitationGroup - Multi-Specialty
No152WP0200XEye and Vision Services ProvidersOptometristPediatricsGroup - Multi-Specialty
No152WS0006XEye and Vision Services ProvidersOptometristSports VisionGroup - Multi-Specialty
No152WV0400XEye and Vision Services ProvidersOptometristVision TherapyGroup - Multi-Specialty
No152WX0102XEye and Vision Services ProvidersOptometristOccupational VisionGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL046009795Medicaid
TXV04429Medicare UPIN