Provider Demographics
NPI:1861457814
Name:LOUCOPOULOS, JOHN (OD)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:
Last Name:LOUCOPOULOS
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:PO BOX 1326
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:CT
Mailing Address - Zip Code:06443-1326
Mailing Address - Country:US
Mailing Address - Phone:860-705-7323
Mailing Address - Fax:
Practice Address - Street 1:49 TURNPIKE SQ
Practice Address - Street 2:
Practice Address - City:MILFORD
Practice Address - State:CT
Practice Address - Zip Code:06460-2758
Practice Address - Country:US
Practice Address - Phone:203-878-3098
Practice Address - Fax:203-314-2210
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-20
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH1009152W00000X
CT002540152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
U84894Medicare UPIN
410001163Medicare ID - Type Unspecified