Healthcare Provider Details

I. General information

NPI: 1609844091
Provider Name (Legal Business Name): JOHN LUCAS SMALL O.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 03/10/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5434 CARPINTERIA AVE
CARPINTERIA CA
93013-1423
US

IV. Provider business mailing address

2235 CHAPALA ST
SANTA BARBARA CA
93105-3906
US

V. Phone/Fax

Practice location:
  • Phone: 805-684-5476
  • Fax: 805-684-5477
Mailing address:
  • Phone: 805-921-3023
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number12435T
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: