Provider Demographics
NPI:1629003496
Name:LOTZ, DAVID A (OD)
Entity type:Individual
Prefix:DR
First Name:DAVID
Middle Name:A
Last Name:LOTZ
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 1:1238 HOLLAND RD
Mailing Address - Street 2:SUITE 103
Mailing Address - City:SUFFOLK
Mailing Address - State:VA
Mailing Address - Zip Code:23434-6300
Mailing Address - Country:US
Mailing Address - Phone:757-539-8716
Mailing Address - Fax:
Practice Address - Street 1:1238 HOLLAND RD
Practice Address - Street 2:SUITE 103
Practice Address - City:SUFFOLK
Practice Address - State:VA
Practice Address - Zip Code:23434-6300
Practice Address - Country:US
Practice Address - Phone:757-539-8716
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0618000298152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA9230271Medicaid
VAT83204Medicare UPIN