Provider Demographics
NPI:1053037820
Name:LOOTENS, DOLORES P (OD)
Entity type:Individual
Prefix:DR
First Name:DOLORES
Middle Name:P
Last Name:LOOTENS
Suffix:
Gender:F
Credentials:OD
Other - Prefix:DR
Other - First Name:DOLORES
Other - Middle Name:
Other - Last Name:LOOTENS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:8614 WESTWOOD CENTER DR FL 9
Mailing Address - Street 2:
Mailing Address - City:VIENNA
Mailing Address - State:VA
Mailing Address - Zip Code:22182-2442
Mailing Address - Country:US
Mailing Address - Phone:703-847-8899
Mailing Address - Fax:
Practice Address - Street 1:68 W DUNDEE RD
Practice Address - Street 2:
Practice Address - City:BUFFALO GROVE
Practice Address - State:IL
Practice Address - Zip Code:60089-3758
Practice Address - Country:US
Practice Address - Phone:847-547-3334
Practice Address - Fax:847-547-8442
Is Sole Proprietor?:Yes
Enumeration Date:2022-10-13
Last Update Date:2024-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY009671152W00000X
IL046011798152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist