Healthcare Provider Details

I. General information

NPI: 1497712665
Provider Name (Legal Business Name): LINDA J H LUCAS O.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 04/28/2006
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2401 W. MAIN ST. VA MEDICAL CENTER
MARION IL
62959
US

IV. Provider business mailing address

821 S GIANT CITY RD
CARBONDALE IL
62902-5041
US

V. Phone/Fax

Practice location:
  • Phone: 618-997-5311
  • Fax: 618-998-5651
Mailing address:
  • Phone: 618-997-5311
  • Fax: 618-998-5651

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number2342
License Number StateOK
# 2
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number02167
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: