Provider Demographics
NPI:1528297900
Name:LOFGRAN, ADAM JEFFREY (OD)
Entity type:Individual
Prefix:DR
First Name:ADAM
Middle Name:JEFFREY
Last Name:LOFGRAN
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:749 S RIVER RD
Mailing Address - Street 2:
Mailing Address - City:ST GEORGE
Mailing Address - State:UT
Mailing Address - Zip Code:84790-5509
Mailing Address - Country:US
Mailing Address - Phone:435-628-4464
Mailing Address - Fax:435-628-5015
Practice Address - Street 1:749 S RIVER RD
Practice Address - Street 2:
Practice Address - City:ST GEORGE
Practice Address - State:UT
Practice Address - Zip Code:84790
Practice Address - Country:US
Practice Address - Phone:435-628-4464
Practice Address - Fax:435-628-5015
Is Sole Proprietor?:Yes
Enumeration Date:2009-07-07
Last Update Date:2018-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT73705719934152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
000067836Medicare UPIN