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NPI Code Detail

MEDICARE: LUCAS TRIM OD

MEDICARE: LUCAS TRIM OD
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
1152W00000XOptometrist6126FL
2152W00000XOptometristOPC6126FL

General Provider Information

NPI Number : 1336868991
Entity Type Code : Individual
Provider Name (Legal Business Name) : LUCAS TRIM OD
Provider Business Mailing Address
First Line : PO BOX 11407
Second Line :
City : BIRMINGHAM
State : AL
Zip : 35246-8575
Country : US
Telephone Number : 864-359-1308
Fax Number : 239-496-3939
Provider Business Practice Location Address
First Line : 2111 BEE RIDGE RD
Second Line :
City : SARASOTA
State : FL
Zip : 34239-6104
Country : US
Telephone Number : 941-792-2020
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/25/2022
Last Update Date : 04/30/2026

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Directions to “ LUCAS TRIM OD” Practice Location

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