Provider Demographics
NPI:1144355140
Name:LOONEY, BRIAN D (OD)
Entity type:Individual
Prefix:
First Name:BRIAN
Middle Name:D
Last Name:LOONEY
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:PO BOX 45923
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21297-5923
Mailing Address - Country:US
Mailing Address - Phone:877-969-0392
Mailing Address - Fax:
Practice Address - Street 1:125 SUFFOLK AVE
Practice Address - Street 2:
Practice Address - City:RICHLANDS
Practice Address - State:VA
Practice Address - Zip Code:24641-2434
Practice Address - Country:US
Practice Address - Phone:276-963-0808
Practice Address - Fax:276-935-2993
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-22
Last Update Date:2022-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV1011-OD152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV1458599OtherUMWA
WV001705926OtherMOUNTAIN STATE BLUE CROSS