MEDICARE: MR. LOREN A POLTE OD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	152W00000X	Optometrist	7556T	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1508850132
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. LOREN A POLTE OD

Provider Business Mailing Address
First Line	:	2920 COLD SPRINGS RD
Second Line	:	SUITE B
City	:	PLACERVILLE
State	:	CA
Zip	:	95667-4220
Country	:	US
Telephone Number	:	530-626-7460
Fax Number	:	530-622-0719

Provider Business Practice Location Address
First Line	:	2920 COLD SPRINGS RD
Second Line	:	SUITE B
City	:	PLACERVILLE
State	:	CA
Zip	:	95667-4220
Country	:	US
Telephone Number	:	530-626-7460
Fax Number	:	530-622-0719

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/09/2005
Last Update Date	:	07/08/2007

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