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General NPI Number Information
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NPI Number | 1184784308
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Entity Type | Individual
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Provider Name | LUC R JONCAS O.D.
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Gender | Male
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Dates
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Enumeration Date | 12/11/2006
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Last Update Date | 03/26/2010
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Provider Practice Location Address
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Address Line | 5346 W SAGINAW HWY LANSING MALL
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City | LANSING
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State | MI
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Zip | 48917-2455
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Country | US
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Telephone | 517-321-5545
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Fax | 517-321-8344
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Provider Business Mailing Address
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Address Line | 3918 HAZY LN
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City | OKEMOS
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State | MI
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Zip | 48864-5226
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Country | US
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Telephone | 517-321-5545
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Fax | 517-321-8344
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number | 4901002969
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License Number State | MI
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