Provider Demographics
NPI:1881839983
Name:LOOKING GLASS EYECARE PROFESSIONALS LLC
Entity Type:Organization
Organization Name:LOOKING GLASS EYECARE PROFESSIONALS LLC
Other - Org Name:LOUDONVILLE FAMILY VISION
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/OPTOMETRIST
Authorized Official - Prefix:DR
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:MILLER
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:419-994-3071
Mailing Address - Street 1:631 N UNION ST
Mailing Address - Street 2:
Mailing Address - City:LOUDONVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:44842-1074
Mailing Address - Country:US
Mailing Address - Phone:419-994-3071
Mailing Address - Fax:419-994-4422
Practice Address - Street 1:631 N UNION ST
Practice Address - Street 2:
Practice Address - City:LOUDONVILLE
Practice Address - State:OH
Practice Address - Zip Code:44842-1074
Practice Address - Country:US
Practice Address - Phone:419-994-3071
Practice Address - Fax:419-994-4422
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-12-04
Last Update Date:2008-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH5806152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty