Healthcare Provider Details

I. General information

NPI: 1902876048
Provider Name (Legal Business Name): GERARD N. LOZADA O.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/23/2006
Last Update Date: 03/07/2023
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7355 W 97TH ST
OVERLAND PARK KS
66212-2210
US

IV. Provider business mailing address

7355 W 97TH ST
OVERLAND PARK KS
66212-2210
US

V. Phone/Fax

Practice location:
  • Phone: 913-648-2021
  • Fax: 913-648-7762
Mailing address:
  • Phone: 913-648-2021
  • Fax: 913-648-7762

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152WC0802X
TaxonomyCorneal and Contact Management Optometrist
License Number13813
License Number StateKS

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: