1881762342 NPI number — LUCAS EYE CARE PLLC

Table of content: (NPI 1881762342)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1881762342 NPI number — LUCAS EYE CARE PLLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
LUCAS EYE CARE PLLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1881762342
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/15/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
HC 74 BOX 3034
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CHAPMANVILLE
Provider Business Mailing Address State Name:
WV
Provider Business Mailing Address Postal Code:
25508-9525
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
304-855-4345
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
113 LB AND T WAY
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LOGAN
Provider Business Practice Location Address State Name:
WV
Provider Business Practice Location Address Postal Code:
25601-3485
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
304-752-2020
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
12/01/2006

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
LUCAS
Authorized Official First Name:
LONNIE
Authorized Official Middle Name:
KENT
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
304-855-4345

Provider Taxonomy Codes

  • Taxonomy code: 152W00000X , with the licence number:  1038 , registered in the state of WV ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 3810007321 , issued by the state of ( WV ) . This identifiers is of the category "MEDICAID".