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General NPI Number Information
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NPI Number | 1619964038
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Entity Type | Organization
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Legal Business Name | JAN S LUKAC MD INC
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Dates
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Enumeration Date | 09/30/2005
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Last Update Date | 01/02/2019
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Provider Practice Location Address
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Address Line | 380 W CENTRAL AVE STE 300
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City | BREA
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State | CA
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Zip | 92821-3014
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Country | US
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Telephone | 714-529-9563
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Fax | 714-529-8476
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Provider Business Mailing Address
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Address Line | 380 W CENTRAL AVE STE 300
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City | BREA
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State | CA
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Zip | 92821-3014
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Country | US
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Telephone | 714-529-9563
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Fax | 714-529-8476
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Authorized Official
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Title or Position | OWNER
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Name | DR. JAN S LUKAC
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Credential | MD
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Telephone | 714-529-9563
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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 | A32888
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License Number State | CA
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