Provider Demographics
NPI:1790053056
Name:LOEW VISION OPTOMETRIC SERVICES, INC.
Entity Type:Organization
Organization Name:LOEW VISION OPTOMETRIC SERVICES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:J
Authorized Official - Last Name:SUPER
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:310-500-8867
Mailing Address - Street 1:239 S LA CIENEGA BLVD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:BEVERLY HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:90211-3328
Mailing Address - Country:US
Mailing Address - Phone:310-553-0100
Mailing Address - Fax:424-288-4893
Practice Address - Street 1:239 S LA CIENEGA BLVD
Practice Address - Street 2:SUITE 100
Practice Address - City:BEVERLY HILLS
Practice Address - State:CA
Practice Address - Zip Code:90211-3328
Practice Address - Country:US
Practice Address - Phone:310-553-0100
Practice Address - Fax:424-288-4893
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-12-01
Last Update Date:2011-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152WL0500XEye and Vision Services ProvidersOptometristLow Vision RehabilitationGroup - Multi-Specialty
No103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Multi-Specialty
No152W00000XEye and Vision Services ProvidersOptometristGroup - Multi-Specialty
No225XL0004XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistLow VisionGroup - Multi-Specialty