Healthcare Provider Details

I. General information

NPI: 1265728356
Provider Name (Legal Business Name): LANA JEAN LUKAS O.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/27/2011
Last Update Date: 11/07/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

757 E LEWIS AND CLARK PKWY
CLARKSVILLE IN
47129-2269
US

IV. Provider business mailing address

326 COPPERCREEK CIR
LOUISVILLE KY
40222-6808
US

V. Phone/Fax

Practice location:
  • Phone: 812-288-8566
  • Fax: 812-284-2326
Mailing address:
  • Phone: 812-327-5095
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number18003674A
License Number StateIN
# 2
Primary TaxonomyN
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number1858DT
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: