Individual
DR. KENNETH J LOSSMAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
OD
Contact information
Practice address
950 W MAIN ST, SUITE 125, LAKE ZURICH, IL 60047
(847) 726-2020
(847) 726-2036
Mailing address
950 W MAIN ST, SUITE 125, LAKE ZURICH, IL 60047-3422
(847) 726-2020
(847) 726-2036
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
046006871
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0400720003
DMERC
IL
05
—
046006871
—
IL
01
—
P00278327
RAILROAD MEDICARE
IL
Enumeration date
10/25/2006
Last updated
04/14/2014
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