Provider Demographics
NPI:1538581947
Name:KEVIN G. LOESCH OD LLC
Entity type:Organization
Organization Name:KEVIN G. LOESCH OD LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPTOMETRIST
Authorized Official - Prefix:
Authorized Official - First Name:KEVIN
Authorized Official - Middle Name:G
Authorized Official - Last Name:LOESCH
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:859-635-0948
Mailing Address - Street 1:119 HUNTERS HL
Mailing Address - Street 2:
Mailing Address - City:ALEXANDRIA
Mailing Address - State:KY
Mailing Address - Zip Code:41001-8576
Mailing Address - Country:US
Mailing Address - Phone:859-635-6179
Mailing Address - Fax:
Practice Address - Street 1:6711 ALEXANDRIA PIKE
Practice Address - Street 2:
Practice Address - City:ALEXANDRIA
Practice Address - State:KY
Practice Address - Zip Code:41001-1025
Practice Address - Country:US
Practice Address - Phone:859-635-0948
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-01-21
Last Update Date:2014-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY1272DT152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY7100155840Medicaid
KY9934301Medicare PIN
KY7100155840Medicaid