MEDICARE: MR. DAVID W LUCAS 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	4901002338	MI

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1710056304
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. DAVID W LUCAS OD

Provider Business Mailing Address
First Line	:	228 N HELMER RD
Second Line	:
City	:	SPRINGFIELD
State	:	MI
Zip	:	49037-7931
Country	:	US
Telephone Number	:	269-963-5640
Fax Number	:	269-963-1666

Provider Business Practice Location Address
First Line	:	228 N HELMER RD
Second Line	:
City	:	SPRINGFIELD
State	:	MI
Zip	:	49037-7931
Country	:	US
Telephone Number	:	269-963-5640
Fax Number	:	269-963-1666

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

Provider Enumeration Date	:	11/07/2006
Last Update Date	:	10/11/2011

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