MEDICARE: LOUCOPOULOS OPTOMETRISTS, LLC

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	002540	CT

General Provider Information

NPI Number	:	1871670315
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LOUCOPOULOS OPTOMETRISTS, LLC

Provider Business Mailing Address
First Line	:	PO BOX 1326
Second Line	:
City	:	MADISON
State	:	CT
Zip	:	06443-1326
Country	:	US
Telephone Number	:	860-705-7323
Fax Number	:

Provider Business Practice Location Address
First Line	:	49 TURNPIKE SQ
Second Line	:
City	:	MILFORD
State	:	CT
Zip	:	06460-2758
Country	:	US
Telephone Number	:	203-878-3098
Fax Number	:	203-314-2210

Authorized Official
Title or Position	:	SOLE MEMBER
Name	:	DR. JOHN LOUCOPOULOS
Credential	:	O.D.
Telephone Number	:	860-705-7323

Provider Enumeration Date	:	11/01/2006
Last Update Date	:	05/10/2024

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