MEDICARE: DR. DAVID LOHR II 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	1859	CO
2	152WC0802X	Corneal and Contact Management Optometrist	1859	CO
3	152WP0200X	Pediatric Optometrist	1859	CO
4	152WV0400X	Vision Therapy Optometrist	1859	CO
5	152W00000X	Optometrist	5139T	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	841477360	OTHER	CO	TAX ID

General Provider Information

NPI Number	:	1942293980
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. DAVID LOHR II O.D.

Provider Business Mailing Address
First Line	:	13570 MEADOWGRASS DR STE 205
Second Line	:
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80921-3058
Country	:	US
Telephone Number	:	719-266-9095
Fax Number	:	719-266-9068

Provider Business Practice Location Address
First Line	:	13570 MEADOWGRASS DR STE 205
Second Line	:
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80921-3058
Country	:	US
Telephone Number	:	719-266-9095
Fax Number	:	719-266-9068

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

Provider Enumeration Date	:	08/24/2005
Last Update Date	:	12/01/2010

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