Provider Demographics
NPI:1821078163
Name:JENNIFER L. LOAR OD PA
Entity Type:Organization
Organization Name:JENNIFER L. LOAR OD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPTOMETRIST/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:L
Authorized Official - Last Name:LOAR
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:772-589-8654
Mailing Address - Street 1:7785 144TH ST STE A2A
Mailing Address - Street 2:
Mailing Address - City:SEBASTIAN
Mailing Address - State:FL
Mailing Address - Zip Code:32958-3207
Mailing Address - Country:US
Mailing Address - Phone:772-589-8654
Mailing Address - Fax:772-581-3870
Practice Address - Street 1:1103 US HIGHWAY 1
Practice Address - Street 2:STE 2
Practice Address - City:SEBASTIAN
Practice Address - State:FL
Practice Address - Zip Code:32958-8660
Practice Address - Country:US
Practice Address - Phone:772-589-8654
Practice Address - Fax:772-581-3870
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-01-20
Last Update Date:2019-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOPC3138152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL20862OtherBCBS
FLDD3585OtherRR MEDICARE
FLK3354Medicare PIN
FLDD3585OtherRR MEDICARE
FL20862OtherBCBS