MEDICARE: JUSTIN VUONG LUCIDO OD

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	1161	NV

General Provider Information

NPI Number	:	1700579125
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JUSTIN VUONG LUCIDO OD

Provider Business Mailing Address
First Line	:	6160 W TROPICANA AVE STE E4
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89103-4696
Country	:	US
Telephone Number	:	702-452-2020
Fax Number	:	702-906-2564

Provider Business Practice Location Address
First Line	:	6160 W TROPICANA AVE STE E4
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89103-4696
Country	:	US
Telephone Number	:	702-452-2020
Fax Number	:	702-906-2564

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/31/2023
Last Update Date	:	02/26/2025

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