Provider Demographics
NPI:1821013582
Name:LOHRBERG, JAMES DONALD (OD)
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:DONALD
Last Name:LOHRBERG
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 1:1104 NORTH VERMILION STREET
Mailing Address - Street 2:
Mailing Address - City:DANVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:61832
Mailing Address - Country:US
Mailing Address - Phone:217-442-2361
Mailing Address - Fax:217-442-0119
Practice Address - Street 1:1104 NORTH VERMILION STREET
Practice Address - Street 2:
Practice Address - City:DANVILLE
Practice Address - State:IL
Practice Address - Zip Code:61832
Practice Address - Country:US
Practice Address - Phone:217-442-2631
Practice Address - Fax:217-442-0119
Is Sole Proprietor?:No
Enumeration Date:2006-07-13
Last Update Date:2014-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL046008041152W00000X
IN18002343A152W00000X
IN18002343B152W00000X
IN18002343A&18002343B152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN100314050AOtherMEDICAID
1269286LOHROtherUNITED MINE WORKERS
189575OtherHIGHMARK PENN BLUESHIELD
004073OtherHEALTH ALLIANCE INSURANCE
180031597OtherMEDICARE RAILROAD
IL046008041Medicaid
T39008Medicare UPIN
K18032Medicare ID - Type Unspecified