Healthcare Provider Details

I. General information

NPI: 1326079575
Provider Name (Legal Business Name): ERICA LUKASKO O.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/05/2006
Last Update Date: 12/20/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4906 AMBASSADOR CAFFERY PKWY BLDG G
LAFAYETTE LA
70508-6962
US

IV. Provider business mailing address

4906 AMBASSADOR CAFFERY PKWY SUITE 701, BUILDING G
LAFAYETTE LA
70508-6962
US

V. Phone/Fax

Practice location:
  • Phone: 337-989-2600
  • Fax: 337-993-2920
Mailing address:
  • Phone: 337-989-2600
  • Fax: 337-993-2920

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License NumberLA#1392-523T
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: