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General NPI Number Information
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NPI Number | 1497945943
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Entity Type | Organization
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Legal Business Name | ROGER W. LUCK
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Dates
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Enumeration Date | 07/31/2007
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Last Update Date | 06/18/2008
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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 |
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Provider Business Mailing 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 |
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Authorized Official
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Title or Position | OWNER
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Name | MR. ROGER WAYNE LUCK
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Credential | OPTICIAN
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Telephone | 910-997-4949
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 332H00000X
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Taxonomy Name | Eyewear Supplier
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License Number | 398
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License Number State | NC
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