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General NPI Number Information
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NPI Number | 1740431626
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Entity Type | Organization
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Legal Business Name | ENGLEWOOD OPTOMETRY LLC
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Dates
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Enumeration Date | 10/09/2008
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Last Update Date | 04/21/2011
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Provider Practice Location Address
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Address Line | 621 WOODSIDE DR
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City | ENGLEWOOD
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State | OH
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Zip | 45322-1838
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Country | US
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Telephone | 937-836-6621
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Fax | 937-836-6621
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Provider Business Mailing Address
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Address Line | 621 WOODSIDE DR
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City | ENGLEWOOD
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State | OH
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Zip | 45322-1838
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Country | US
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Telephone | 937-836-6621
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Fax | 937-836-6621
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Authorized Official
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Title or Position | OWNER/DOCTOR
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Name | DR. JOHN ROBERT LOESCH
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Credential | OD
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Telephone | 937-836-6621
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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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