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NPI Code Detail

MEDICARE: KEVIN G. LOESCH OD LLC

MEDICARE: KEVIN G. LOESCH OD LLC
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
1152W00000XOptometrist1272DTKY

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1538581947
Entity Type Code : Organization
Provider Name (Legal Business Name) : KEVIN G. LOESCH OD LLC
Provider Business Mailing Address
First Line : 119 HUNTERS HL
Second Line :
City : ALEXANDRIA
State : KY
Zip : 41001-8576
Country : US
Telephone Number : 859-635-6179
Fax Number :
Provider Business Practice Location Address
First Line : 6711 ALEXANDRIA PIKE
Second Line :
City : ALEXANDRIA
State : KY
Zip : 41001-1025
Country : US
Telephone Number : 859-635-0948
Fax Number :
Authorized Official
Title or Position : OPTOMETRIST
Name : KEVIN G LOESCH
Credential : OD
Telephone Number : 859-635-0948
Provider Enumeration Date : 01/21/2014
Last Update Date : 02/06/2014

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