Provider Demographics
NPI:1942379540
Name:LOAR, JENNIFER (OD)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:
Last Name:LOAR
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 1:7785 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 1:7785 144TH ST STE A2A
Practice Address - Street 2:
Practice Address - City:SEBASTIAN
Practice Address - State:FL
Practice Address - Zip Code:32958-3207
Practice Address - Country:US
Practice Address - Phone:772-589-8654
Practice Address - Fax:772-581-3870
Is Sole Proprietor?:No
Enumeration Date:2006-11-07
Last Update Date:2019-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOP0003138152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL410049883OtherRR MEDICARE
FL20862OtherBLUE CROSS
FLU70113Medicare UPIN
FL20862OtherBLUE CROSS
FLE0544BMedicare ID - Type Unspecified