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General NPI Number Information
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NPI Number | 1790920379
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Entity Type | Organization
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Legal Business Name | LUCAS OPTOMETRY, INC.
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Dates
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Enumeration Date | 12/10/2008
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Last Update Date | 12/10/2008
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Provider Practice Location Address
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Address Line | 3165 S GRAND BLVD
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City | SAINT LOUIS
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State | MO
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Zip | 63118-1021
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Country | US
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Telephone | 314-772-3737
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Fax | 314-664-7722
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Provider Business Mailing Address
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Address Line | 3165 S GRAND BLVD
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City | SAINT LOUIS
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State | MO
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Zip | 63118-1021
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Country | US
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Telephone | 314-772-3737
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Fax | 314-664-7722
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Authorized Official
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Title or Position | VICE PRESIDENT
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Name | DR. TODD N. LUCAS
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Credential | O.D.
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Telephone | 314-772-3737
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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 | TO2350
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License Number State | MO
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Taxonomy #2
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number | TO2570
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License Number State | MO
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