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General NPI Number Information
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NPI Number | 1750993580
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Entity Type | Organization
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Legal Business Name | LOWES BOULEVARD VISION
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Dates
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Enumeration Date | 08/22/2020
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Last Update Date | 02/01/2021
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Provider Practice Location Address
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Address Line | 1400 LOWES BLVD
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City | KILLEEN
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State | TX
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Zip | 76542-5201
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Country | US
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Telephone | 254-246-8205
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Fax | 254-246-8206
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Provider Business Mailing Address
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Address Line | 1400 LOWES BLVD
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City | KILLEEN
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State | TX
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Zip | 76542-5201
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Country | US
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Telephone | 254-246-8205
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Fax | 254-246-8206
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. THOMAS ALLEN LUCAS JR.
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Credential | OD
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Telephone | 254-690-4733
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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 |
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License Number State |
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