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General NPI Number Information
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NPI Number | 1194800011
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Entity Type | Individual
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Provider Name | JEFFREY LUTSKY OPTICIAN
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Gender | Male
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Dates
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Enumeration Date | 10/26/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 1330 PARKWAY AVE EYESTYLES
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City | TRENTON
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State | NJ
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Zip | 08628-3006
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Country | US
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Telephone | 609-883-1800
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Fax |
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Provider Business Mailing Address
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Address Line | 31 STONEGATE DR
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City | WATCHUNG
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State | NJ
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Zip | 07069-5471
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Country | US
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Telephone | 908-229-4266
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Fax |
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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 | 156FX1800X
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Taxonomy Name | Optician
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License Number | TD1927
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License Number State | NJ
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