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General NPI Number Information
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NPI Number | 1386723237
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Entity Type | Individual
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Provider Name | ROGER WAYNE LUCK OPTICIAN
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Gender | Male
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Dates
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Enumeration Date | 11/03/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 211 W BROAD AVE
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City | ROCKINGHAM
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State | NC
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Zip | 28379-3529
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Country | US
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Telephone | 910-997-4949
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Fax | 910-997-4111
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Provider Business Mailing Address
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Address Line | PO BOX 121
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City | NORMAN
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State | NC
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Zip | 28367-0121
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Country | US
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Telephone | 910-652-5664
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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 | 398
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License Number State | NC
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