MEDICARE: LUX EYEWEAR FOR LESS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	152W00000X	Optometrist	2393	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	2393	OTHER	TX	OPTOMETRY LICENSE

General Provider Information

NPI Number	:	1609911171
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LUX EYEWEAR FOR LESS

Provider Business Mailing Address
First Line	:	400 E SEMINARY DR
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76115-2628
Country	:	US
Telephone Number	:	817-923-9329
Fax Number	:	817-923-2285

Provider Business Practice Location Address
First Line	:	400 E SEMINARY DR
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76115-2628
Country	:	US
Telephone Number	:	817-923-9329
Fax Number	:	817-923-2285

Authorized Official
Title or Position	:	OWNER
Name	:	DR. WILLIAM J. LUCK
Credential	:	O.D.
Telephone Number	:	817-923-9329

Provider Enumeration Date	:	02/21/2007
Last Update Date	:	07/09/2008

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