Healthcare Provider Details

I. General information

NPI: 1326782244
Provider Name (Legal Business Name): COURTNEY LYNN LUCE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/26/2022
Last Update Date: 07/09/2026
Certification Date: 07/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

720 WASHINGTON AVE SE STE 300
MINNEAPOLIS MN
55414-2904
US

IV. Provider business mailing address

720 WASHINGTON AVE SE STE 300
MINNEAPOLIS MN
55414-2904
US

V. Phone/Fax

Practice location:
  • Phone: 612-884-0930
  • Fax: 612-676-8992
Mailing address:
  • Phone: 612-884-0930
  • Fax: 612-676-8992

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number4071
License Number StateMN
# 2
Primary TaxonomyN
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number046011621
License Number StateIL
# 3
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: