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NPI Code Detail

MEDICARE: DR. MARCIA LYNN LUSK O.D.

MEDICARE: DR. MARCIA LYNN LUSK O.D.
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
1152W00000XOptometristOPC 3601FL

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1922137OTHERFLEYEMED PROVIDER NUMBER

General Provider Information

NPI Number : 1619192846
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. MARCIA LYNN LUSK O.D.
Provider Business Mailing Address
First Line : 777 E MERRITT ISLAND CSWY
Second Line : SUITE 200A
City : MERRITT ISLAND
State : FL
Zip : 32952-3576
Country : US
Telephone Number : 321-454-9909
Fax Number :
Provider Business Practice Location Address
First Line : 777 E MERRITT ISLAND CSWY
Second Line : SUITE 200A
City : MERRITT ISLAND
State : FL
Zip : 32952-3576
Country : US
Telephone Number : 321-454-9909
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/14/2007
Last Update Date : 07/08/2007

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