Provider Demographics
NPI:1124166426
Name:LOEPER, DAVID C (OD)
Entity type:Individual
Prefix:
First Name:DAVID
Middle Name:C
Last Name:LOEPER
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:801 E WASHINGTON ST
Mailing Address - Street 2:SUITE 120
Mailing Address - City:MEDINA
Mailing Address - State:OH
Mailing Address - Zip Code:44256-3335
Mailing Address - Country:US
Mailing Address - Phone:330-725-6655
Mailing Address - Fax:330-722-5544
Practice Address - Street 1:801 E WASHINGTON ST
Practice Address - Street 2:SUITE 120
Practice Address - City:MEDINA
Practice Address - State:OH
Practice Address - Zip Code:44256-3335
Practice Address - Country:US
Practice Address - Phone:330-725-6655
Practice Address - Fax:330-722-5544
Is Sole Proprietor?:No
Enumeration Date:2007-02-01
Last Update Date:2008-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH4602152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH1084600001OtherD MERC#
OH0773243Medicare PIN
OHU52186Medicare UPIN