Healthcare Provider Details

I. General information

NPI: 1366413023
Provider Name (Legal Business Name): JODI IAN LUCHS M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/31/2006
Last Update Date: 01/09/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1515 N FLAGLER DR STE 500
WEST PALM BEACH FL
33401-3430
US

IV. Provider business mailing address

1050 SE MONTEREY RD STE 104
STUART FL
34994-4512
US

V. Phone/Fax

Practice location:
  • Phone: 561-659-9700
  • Fax: 561-659-7153
Mailing address:
  • Phone: 772-283-2020
  • Fax: 772-219-7924

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number190065
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License NumberME137741
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: