MEDICARE: DR. BRIAN D. LOPATIN O.D.

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	T03191	MO

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	P00403024	OTHER	MO	RR MEDICARE
5	410048354	OTHER	IL	RR MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	115889	OTHER	BLUE CROSS BLUE SHIELD MO
4	23056	OTHER	OPTICARE MED. COMPLETE
6	PENDING	OTHER	GROUP HEALTH PLAN
7	MO3191	OTHER	EYEMED
8	21176	OTHER	HEALTHCARE
9	UNKNOWN	OTHER	DAVIS VISION
10	22-00106	OTHER	UNITED HEALTHCARE
11	115889	OTHER	BLUE CHOICE
12	674835	OTHER	HEALTHLINK
13	U89401	OTHER	MERCY HEALTH PLANS
14	UNKNOWN	OTHER	VISION CARE PLAN

General Provider Information

NPI Number	:	1710946991
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. BRIAN D. LOPATIN O.D.

Provider Business Mailing Address
First Line	:	211 E BROADWAY
Second Line	:
City	:	ALTON
State	:	IL
Zip	:	62002-6220
Country	:	US
Telephone Number	:	314-533-1898
Fax Number	:	800-432-6004

Provider Business Practice Location Address
First Line	:	4145 LINDELL BLVD
Second Line	:
City	:	SAINT LOUIS
State	:	MO
Zip	:	63108-2913
Country	:	US
Telephone Number	:	314-533-1898
Fax Number	:	800-432-6004

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

Provider Enumeration Date	:	03/17/2006
Last Update Date	:	12/19/2012

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