Provider Demographics
NPI:1295999456
Name:LOUPRASONG, AMBER C (OD)
Entity type:Individual
Prefix:DR
First Name:AMBER
Middle Name:C
Last Name:LOUPRASONG
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1750 S ERIE HWY
Mailing Address - Street 2:
Mailing Address - City:HAMILTON
Mailing Address - State:OH
Mailing Address - Zip Code:45011-4118
Mailing Address - Country:US
Mailing Address - Phone:513-870-9777
Mailing Address - Fax:513-870-0485
Practice Address - Street 1:1750 S ERIE HWY
Practice Address - Street 2:
Practice Address - City:HAMILTON
Practice Address - State:OH
Practice Address - Zip Code:45011-4118
Practice Address - Country:US
Practice Address - Phone:513-870-9444
Practice Address - Fax:513-870-0485
Is Sole Proprietor?:No
Enumeration Date:2008-07-16
Last Update Date:2015-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH5801152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH3121348Medicaid
OHPENDINGMedicare UPIN
OH3121348Medicaid