MEDICARE: DR. CAROL ANNE B LUCHANKO-GANLY 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
1	152W00000X	Optometrist	OEG000361	PA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	OEG000361	OTHER	PA	STATE OPTOMETRY LICENSE
2	481772	OTHER	PA	AETNA PROVIDER ID

General Provider Information

NPI Number	:	1942205976
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. CAROL ANNE B LUCHANKO-GANLY OD

Provider Business Mailing Address
First Line	:	109 HILLSIDE LN
Second Line	:
City	:	KENNETT SQUARE
State	:	PA
Zip	:	19348-2267
Country	:	US
Telephone Number	:	610-444-6703
Fax Number	:

Provider Business Practice Location Address
First Line	:	402 BAYARD RD
Second Line	:	SUITE 200
City	:	KENNETT SQUARE
State	:	PA
Zip	:	19348-1862
Country	:	US
Telephone Number	:	484-770-8132
Fax Number	:

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

Provider Enumeration Date	:	06/16/2005
Last Update Date	:	03/07/2023

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