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General NPI Number Information
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NPI Number | 1285645218
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Entity Type | Organization
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Legal Business Name | CANADIAN EYECARE CLINIC, P.C.
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Dates
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Enumeration Date | 08/11/2006
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Last Update Date | 03/22/2011
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Provider Practice Location Address
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Address Line | 306 MAIN ST
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City | CANADIAN
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State | TX
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Zip | 79014-2215
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Country | US
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Telephone | 806-323-8484
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Fax |
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Provider Business Mailing Address
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Address Line | 306 MAIN ST
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City | CANADIAN
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State | TX
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Zip | 79014-2215
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DR. ROBERT LUSK
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Credential |
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Telephone | 806-323-8484
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number | 2073
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License Number State | OK
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Taxonomy #2
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number | 4674T
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License Number State | TX
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