MEDICARE: DR. LUCAS OLIVER PLATT JR. D.O.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207W00000X	Ophthalmology Physician	E-1470	AR
2	207W00000X	Ophthalmology Physician	MDO.1619DO	SC

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1053385062
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. LUCAS OLIVER PLATT JR. D.O.

Provider Business Mailing Address
First Line	:	1655 BERNARDIN AVE.
Second Line	:	STE 100
City	:	COLUMBIA
State	:	SC
Zip	:	29204-2039
Country	:	US
Telephone Number	:	803-256-0641
Fax Number	:	803-779-3649

Provider Business Practice Location Address
First Line	:	1655 BERNARDIN AVE.
Second Line	:	STE 100
City	:	COLUMBIA
State	:	SC
Zip	:	29204-2039
Country	:	US
Telephone Number	:	803-256-0641
Fax Number	:	803-779-3649

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/15/2006
Last Update Date	:	11/05/2015

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Directions to “ DR. LUCAS OLIVER PLATT JR. D.O.” Practice Location

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