Provider Demographics
NPI:1912903907
Name:LOJKA, GLEN BRIAN (OD)
Entity Type:Individual
Prefix:DR
First Name:GLEN
Middle Name:BRIAN
Last Name:LOJKA
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:PO BOX 207158
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75320-7158
Mailing Address - Country:US
Mailing Address - Phone:636-200-4393
Mailing Address - Fax:636-527-0766
Practice Address - Street 1:194 CLARKSON RD
Practice Address - Street 2:
Practice Address - City:ELLISVILLE
Practice Address - State:MO
Practice Address - Zip Code:63011-2244
Practice Address - Country:US
Practice Address - Phone:636-227-2020
Practice Address - Fax:636-227-9968
Is Sole Proprietor?:No
Enumeration Date:2005-06-23
Last Update Date:2023-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2000170624152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO41047797OtherRAILROAD MEDICARE
MO315949800Medicaid
MOMA5227045Medicare UPIN
MO315949800Medicaid
U82479Medicare UPIN