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General NPI Number Information
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NPI Number | 1538425061
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Entity Type | Organization
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Legal Business Name | LUKETIC EYE CENTER, LLC
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Dates
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Enumeration Date | 04/10/2012
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Last Update Date | 04/10/2012
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Provider Practice Location Address
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Address Line | 3915 SUNFOREST CT
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City | TOLEDO
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State | OH
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Zip | 43623-4453
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Country | US
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Telephone | 419-450-3337
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 8830
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City | TOLEDO
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State | OH
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Zip | 43623-0830
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Country | US
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Telephone | 419-450-3337
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | KARL J. LUKETIC
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Credential | M.D.
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Telephone | 419-450-3337
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207W00000X
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Taxonomy Name | Ophthalmology Physician
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License Number |
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License Number State |
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