Provider Demographics
NPI:1316914856
Name:LOEW, ROBERT CHARLES (OD)
Entity type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:CHARLES
Last Name:LOEW
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:2200 ELMWOOD AVENUE
Mailing Address - Street 2:SUITE D4
Mailing Address - City:LAFAYETTE
Mailing Address - State:IN
Mailing Address - Zip Code:47904
Mailing Address - Country:US
Mailing Address - Phone:765-446-2814
Mailing Address - Fax:765-447-2870
Practice Address - Street 1:2200 ELMWOOD AVENUE
Practice Address - Street 2:SUITE D4
Practice Address - City:LAFAYETTE
Practice Address - State:IN
Practice Address - Zip Code:47904
Practice Address - Country:US
Practice Address - Phone:765-446-2814
Practice Address - Fax:765-447-2870
Is Sole Proprietor?:No
Enumeration Date:2006-03-03
Last Update Date:2014-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN18002145152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN224950AMedicare ID - Type Unspecified
U09728Medicare UPIN