MEDICARE: LOOMIS, YOUNT, PETERSON & ASSOCIATES, PLLC

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	1057	CO

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	CK8660	OTHER	CO	RAILROAD MEDICARE

General Provider Information

NPI Number	:	1619960580
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LOOMIS, YOUNT, PETERSON & ASSOCIATES, PLLC

Provider Business Mailing Address
First Line	:	7761 SHAFFER PKWY
Second Line	:	STE 200
City	:	LITTLETON
State	:	CO
Zip	:	80127-3731
Country	:	US
Telephone Number	:	303-979-4505
Fax Number	:	303-933-0714

Provider Business Practice Location Address
First Line	:	7761 SHAFFER PKWY
Second Line	:	STE 200
City	:	LITTLETON
State	:	CO
Zip	:	80127-3731
Country	:	US
Telephone Number	:	303-979-4505
Fax Number	:	303-933-0714

Authorized Official
Title or Position	:	BILLING MANAGER
Name	:	KATHY C LOOMIS
Credential	:
Telephone Number	:	303-979-4505

Provider Enumeration Date	:	08/25/2005
Last Update Date	:	05/02/2011

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