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NPI Code Detail

MEDICARE: JONATHAN K. LOO OD, A PROFESSIONAL CORP.

MEDICARE: JONATHAN K. LOO OD, A PROFESSIONAL CORP.
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
1152WC0802XCorneal and Contact Management OptometristOPT5901TPACA

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 : 1851621312
Entity Type Code : Organization
Provider Name (Legal Business Name) : JONATHAN K. LOO OD, A PROFESSIONAL CORP.
Provider Business Mailing Address
First Line : 1111 W ROBINHOOD DR
Second Line : SUITE L
City : STOCKTON
State : CA
Zip : 95207-5626
Country : US
Telephone Number : 209-952-0821
Fax Number : 209-952-0825
Provider Business Practice Location Address
First Line : 1111 W ROBINHOOD DR
Second Line : SUITE L
City : STOCKTON
State : CA
Zip : 95207-5626
Country : US
Telephone Number : 209-952-0821
Fax Number : 209-952-0825
Authorized Official
Title or Position : OPTOMETRIST
Name : DR. JONATHAN K LOO
Credential : O.D.
Telephone Number : 209-952-0821
Provider Enumeration Date : 01/06/2010
Last Update Date : 02/26/2014

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