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General NPI Number Information
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NPI Number | 1710151071
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Entity Type | Organization
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Legal Business Name | JOHN R LOESCH OD
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Dates
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Enumeration Date | 04/17/2008
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Last Update Date | 04/17/2008
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Provider Practice Location Address
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Address Line | 3721 N MAIN ST
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City | DAYTON
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State | OH
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Zip | 45405
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Country | US
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Telephone | 937-278-5689
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Fax | 937-278-6781
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Provider Business Mailing Address
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Address Line | 3721 N MAIN ST
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City | DAYTON
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State | OH
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Zip | 45405
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Country | US
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Telephone | 937-278-5689
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Fax | 937-278-6781
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Authorized Official
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Title or Position | OWNER
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Name | MR. JOHN R LOESCH
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Credential | OD
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Telephone | 937-278-5689
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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 | 3184T545
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License Number State | OH
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