Provider Demographics
NPI:1891768727
Name:LOBERT, RENEE L (OD)
Entity Type:Individual
Prefix:DR
First Name:RENEE
Middle Name:L
Last Name:LOBERT
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2700 FIVE MILE RD. NE
Mailing Address - Street 2:
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49525
Mailing Address - Country:US
Mailing Address - Phone:616-361-6612
Mailing Address - Fax:616-361-6690
Practice Address - Street 1:2700 FIVE MILE RD. NE
Practice Address - Street 2:
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49525
Practice Address - Country:US
Practice Address - Phone:616-361-6612
Practice Address - Fax:616-361-6690
Is Sole Proprietor?:No
Enumeration Date:2006-02-10
Last Update Date:2015-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4901003334152WC0802X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152WC0802XEye and Vision Services ProvidersOptometristCorneal and Contact Management
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI07450OtherPRIORITY HEALTH
MI900D166330OtherBLUE CROSS BLUE SHIELD
MIU24285Medicare UPIN
MI900D166330OtherBLUE CROSS BLUE SHIELD
MI07450OtherPRIORITY HEALTH