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NPI Code Detail

MEDICARE: DR. LUKE WERKHOVEN O.D.

MEDICARE: DR. LUKE WERKHOVEN O.D.
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
1152WL0500XLow Vision Rehabilitation Optometrist11977TCA
2152WC0802XCorneal and Contact Management Optometrist11977TCA

Medicare Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
3WY622OTHERMEDICARE

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
111977TOTHERCASTATE OPT LISC. #
259-3792228OTHERCURRENT TAX ID #
477-0049461OTHEROLD TAX ID#

General Provider Information

NPI Number : 1861425662
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. LUKE WERKHOVEN O.D.
Provider Business Mailing Address
First Line : 5300 HOLLISTER AVE
Second Line :
City : SANTA BARBARA
State : CA
Zip : 93111-2306
Country : US
Telephone Number : 805-692-6977
Fax Number :
Provider Business Practice Location Address
First Line : 5300 HOLLISTER AVE
Second Line :
City : SANTA BARBARA
State : CA
Zip : 93111-2306
Country : US
Telephone Number : 805-692-6977
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/08/2006
Last Update Date : 03/07/2023

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