Basic Information
| Provider Information | |||||||||
| NPI: | 1710946991 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | LOPATIN | ||||||||
| FirstName: | BRIAN | ||||||||
| MiddleName: | D. | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | O.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 211 E BROADWAY | ||||||||
| Address2: | |||||||||
| City: | ALTON | ||||||||
| State: | IL | ||||||||
| PostalCode: | 620026220 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3145331898 | ||||||||
| FaxNumber: | 8004326004 | ||||||||
| Practice Location | |||||||||
| Address1: | 4145 LINDELL BLVD | ||||||||
| Address2: | |||||||||
| City: | SAINT LOUIS | ||||||||
| State: | MO | ||||||||
| PostalCode: | 631082913 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3145331898 | ||||||||
| FaxNumber: | 8004326004 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/17/2006 | ||||||||
| LastUpdateDate: | 12/19/2012 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 152W00000X | T03191 | MO | Y | Eye and Vision Services Providers | Optometrist |
ID Information
| ID | Type | State | Issuer | Description | 315083105 | 05 | MO | MEDICAID | P00403024 | 01 | MO | RR MEDICARE | OTHER | 115889 | 01 | BLUE CROSS BLUE SHIELD MO | OTHER | 23056 | 01 | OPTICARE MED. COMPLETE | OTHER | 410048354 | 01 | IL | RR MEDICARE | OTHER | PENDING | 01 | GROUP HEALTH PLAN | OTHER | MO3191 | 01 | EYEMED | OTHER | 21176 | 01 | HEALTHCARE | OTHER | UNKNOWN | 01 | DAVIS VISION | OTHER | 22-00106 | 01 | UNITED HEALTHCARE | OTHER | 115889 | 01 | BLUE CHOICE | OTHER | 674835 | 01 | HEALTHLINK | OTHER | U89401 | 01 | MERCY HEALTH PLANS | OTHER | UNKNOWN | 01 | VISION CARE PLAN | OTHER |