Healthcare Provider Details

I. General information

NPI: 1437152535
Provider Name (Legal Business Name): DR. BRADLEY L LOEB
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/23/2005
Last Update Date: 04/13/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3855 PENN AVE
SINKING SPRING PA
19608-1174
US

IV. Provider business mailing address

3855 PENN AVE
SINKING SPRING PA
19608-1174
US

V. Phone/Fax

Practice location:
  • Phone: 610-678-4552
  • Fax: 610-678-7007
Mailing address:
  • Phone: 610-678-4552
  • Fax: 610-678-7007

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License NumberOEG000058
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: