1033302401 NPI number — PAMELA ANDERSON-LUKE, O.D., P.A.

Table of content: (NPI 1033302401)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1033302401 NPI number — PAMELA ANDERSON-LUKE, O.D., P.A.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
PAMELA ANDERSON-LUKE, O.D., P.A.
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:
6
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:
1033302401
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/23/2025
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 595
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MURPHY
Provider Business Mailing Address State Name:
NC
Provider Business Mailing Address Postal Code:
28906-0595
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
828-837-1134
Provider Business Mailing Address Fax Number:
828-835-8878

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
540 W US HIGHWAY 64
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MURPHY
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
28906-3179
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
828-837-1134
Provider Business Practice Location Address Fax Number:
828-835-8878
Provider Enumeration Date:
08/20/2007

Additional Information

Authorized Official

Authorized Official Last Name:
ANDERSON-LUKE
Authorized Official First Name:
PAMELA
Authorized Official Middle Name:
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
828-837-1134

Provider Taxonomy Codes

  • Taxonomy code: 152W00000X , with the licence number:  1604 , registered in the state of NC ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 1386732717 . This is a "NPI INDIVIDUAL" identifier . This identifiers is of the category "OTHER".
  • Identifier: 2471779A . This is a "MEDICARE INDIVDUAL PIN" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".
  • Identifier: 89093FE , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".




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