Provider Demographics
NPI:1023131570
Name:LOOTENS, ROBERT JOSEPH JR (FNAO)
Entity type:Individual
Prefix:MR
First Name:ROBERT
Middle Name:JOSEPH
Last Name:LOOTENS
Suffix:JR
Gender:M
Credentials:FNAO
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Other - Credentials:
Mailing Address - Street 1:1705 CHRISTY DR
Mailing Address - Street 2:SUITE 103
Mailing Address - City:JEFFERSON CITY
Mailing Address - State:MO
Mailing Address - Zip Code:65101-5195
Mailing Address - Country:US
Mailing Address - Phone:573-635-1333
Mailing Address - Fax:573-635-0529
Practice Address - Street 1:1705 CHRISTY DR
Practice Address - Street 2:SUITE 103
Practice Address - City:JEFFERSON CITY
Practice Address - State:MO
Practice Address - Zip Code:65101-5195
Practice Address - Country:US
Practice Address - Phone:573-635-1333
Practice Address - Fax:573-635-0529
Is Sole Proprietor?:No
Enumeration Date:2007-04-09
Last Update Date:2008-03-05
Deactivation Date:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO0641880001Medicare NSC