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General NPI Number Information
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NPI Number | 1174033377
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Entity Type | Organization
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Legal Business Name | LOONEY ENTERPRISES LLC
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Dates
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Enumeration Date | 10/03/2017
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Last Update Date | 10/03/2017
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Provider Practice Location Address
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Address Line | 125 SUFFOLK AVE
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City | RICHLANDS
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State | VA
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Zip | 24641-2434
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Country | US
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Telephone | 276-963-0808
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 901
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City | GRUNDY
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State | VA
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Zip | 24614-0901
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Country | US
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Telephone | 276-244-0171
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Fax |
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Authorized Official
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Title or Position | PRESIDENT/MEMBER
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Name | DR. BRIAN D LOONEY
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Credential | OD
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Telephone | 304-436-8435
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number | 0618000677
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License Number State | VA
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