Healthcare Provider Details

I. General information

NPI: 1588646822
Provider Name (Legal Business Name): ZOEY KAY LOOMIS OD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/14/2005
Last Update Date: 08/20/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

231 PROSPECT ST SUITE B
FORT MORGAN CO
80701-3161
US

IV. Provider business mailing address

231 PROSPECT ST SUITE B
FORT MORGAN CO
80701-3161
US

V. Phone/Fax

Practice location:
  • Phone: 970-867-3937
  • Fax: 970-867-3037
Mailing address:
  • Phone: 970-867-3937
  • Fax: 970-867-3037

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License NumberOPT 1825
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: