Healthcare Provider Details

I. General information

NPI: 1780402081
Provider Name (Legal Business Name): LUCAS LAMONT AUD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/26/2024
Last Update Date: 03/03/2025
Certification Date: 03/03/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1170 ROYAL AVE
MEDFORD OR
97504-6101
US

IV. Provider business mailing address

1170 ROYAL AVE
MEDFORD OR
97504-6101
US

V. Phone/Fax

Practice location:
  • Phone: 541-494-0500
  • Fax:
Mailing address:
  • Phone: 541-494-0500
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code237600000X
TaxonomyAudiologist-Hearing Aid Fitter
License Number31111
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: