MEDICARE: DR. BRADLEY L LOEB

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	152W00000X	Optometrist	OEG000058	PA

General Provider Information

NPI Number	:	1437152535
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. BRADLEY L LOEB

Provider Business Mailing Address
First Line	:	3855 PENN AVE
Second Line	:
City	:	SINKING SPRING
State	:	PA
Zip	:	19608-1174
Country	:	US
Telephone Number	:	610-678-4552
Fax Number	:	610-678-7007

Provider Business Practice Location Address
First Line	:	3855 PENN AVE
Second Line	:
City	:	SINKING SPRING
State	:	PA
Zip	:	19608-1174
Country	:	US
Telephone Number	:	610-678-4552
Fax Number	:	610-678-7007

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/23/2005
Last Update Date	:	04/13/2010

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