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General NPI Number Information
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NPI Number | 1508850132
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Entity Type | Individual
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Provider Name | LOREN A POLTE OD
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Gender | Male
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Dates
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Enumeration Date | 09/09/2005
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 2920 COLD SPRINGS RD SUITE B
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City | PLACERVILLE
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State | CA
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Zip | 95667-4220
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Country | US
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Telephone | 530-626-7460
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Fax | 530-622-0719
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Provider Business Mailing Address
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Address Line | 2920 COLD SPRINGS RD SUITE B
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City | PLACERVILLE
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State | CA
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Zip | 95667-4220
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Country | US
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Telephone | 530-626-7460
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Fax | 530-622-0719
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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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 | 7556T
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License Number State | CA
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