MEDICARE: MRS. LU ANNE LUERO OPTICIAN

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	156FX1800X	Optician	C005301-1	NY

General Provider Information

NPI Number	:	1174648513
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. LU ANNE LUERO OPTICIAN

Provider Business Mailing Address
First Line	:	1635 MILITARY RD
Second Line	:
City	:	NIAGARA FALLS
State	:	NY
Zip	:	14304-1745
Country	:	US
Telephone Number	:	716-297-9115
Fax Number	:	716-297-4270

Provider Business Practice Location Address
First Line	:	1635 MILITARY RD
Second Line	:
City	:	NIAGARA FALLS
State	:	NY
Zip	:	14304-1745
Country	:	US
Telephone Number	:	716-297-9115
Fax Number	:	716-297-4270

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

Provider Enumeration Date	:	03/21/2007
Last Update Date	:	07/08/2007

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