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General NPI Number Information
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NPI Number | 1316915481
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Entity Type | Individual
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Provider Name | MARK S LUEDKE OD
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Gender | Male
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Dates
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Enumeration Date | 03/14/2006
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Last Update Date | 05/27/2015
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Provider Practice Location Address
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Address Line | 9433 BALM RIVERVIEW RD STE 102
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City | RIVERVIEW
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State | FL
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Zip | 33569-5120
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Country | US
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Telephone | 813-671-2020
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Fax | 813-677-5549
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Provider Business Mailing Address
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Address Line | 9433 BALM RIVERVIEW RD STUITE 102
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City | RIVERVIEW
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State | FL
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Zip | 33569-5120
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Country | US
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Telephone | 813-671-2020
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Fax | 813-677-5549
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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 | OPC2762
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License Number State | FL
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