Provider Demographics
NPI:1336435445
Name:LOUGHRIN, CATHERINE (OD)
Entity Type:Individual
Prefix:
First Name:CATHERINE
Middle Name:
Last Name:LOUGHRIN
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 1:1033 W NORTHLAND AVE STE B
Mailing Address - Street 2:
Mailing Address - City:APPLETON
Mailing Address - State:WI
Mailing Address - Zip Code:54914-1499
Mailing Address - Country:US
Mailing Address - Phone:920-731-4511
Mailing Address - Fax:920-731-9332
Practice Address - Street 1:1033 W NORTHLAND AVE STE B
Practice Address - Street 2:
Practice Address - City:APPLETON
Practice Address - State:WI
Practice Address - Zip Code:54914-1499
Practice Address - Country:US
Practice Address - Phone:920-731-4511
Practice Address - Fax:920-731-9332
Is Sole Proprietor?:No
Enumeration Date:2011-06-27
Last Update Date:2019-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI3222-35152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI100016696Medicaid