=====================================================
General NPI Number Information
=====================================================
NPI Number | 1588646822
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | ZOEY KAY LOOMIS OD
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/14/2005
-----------------------------------------------------
Last Update Date | 08/20/2009
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 231 PROSPECT ST SUITE B
-----------------------------------------------------
City | FORT MORGAN
-----------------------------------------------------
State | CO
-----------------------------------------------------
Zip | 80701-3161
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 970-867-3937
-----------------------------------------------------
Fax | 970-867-3037
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 231 PROSPECT ST SUITE B
-----------------------------------------------------
City | FORT MORGAN
-----------------------------------------------------
State | CO
-----------------------------------------------------
Zip | 80701-3161
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 970-867-3937
-----------------------------------------------------
Fax | 970-867-3037
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 152W00000X
-----------------------------------------------------
Taxonomy Name | Optometrist
-----------------------------------------------------
License Number | OPT 1825
-----------------------------------------------------
License Number State | CO
-----------------------------------------------------