Provider Demographics
NPI:1487056560
Name:LOSH OPTOMETRY LLC
Entity type:Organization
Organization Name:LOSH OPTOMETRY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER/MANAGER
Authorized Official - Prefix:DR
Authorized Official - First Name:RYAN
Authorized Official - Middle Name:K
Authorized Official - Last Name:LOSH
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:660-241-5001
Mailing Address - Street 1:109 S BUCHANAN ST
Mailing Address - Street 2:
Mailing Address - City:MARYVILLE
Mailing Address - State:MO
Mailing Address - Zip Code:64468-2384
Mailing Address - Country:US
Mailing Address - Phone:660-241-5001
Mailing Address - Fax:660-241-5004
Practice Address - Street 1:109 S BUCHANAN ST
Practice Address - Street 2:
Practice Address - City:MARYVILLE
Practice Address - State:MO
Practice Address - Zip Code:64468-2384
Practice Address - Country:US
Practice Address - Phone:660-241-5001
Practice Address - Fax:660-241-5004
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-09-21
Last Update Date:2015-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOLC1394389152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty