MEDICARE: DR. JENNIFER D LUCKIE 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
1	152W00000X	Optometrist	TA2561	MD
2	152W00000X	Optometrist	0618002458	VA
3	152W00000X	Optometrist	OP1000339	DC

General Provider Information

NPI Number	:	1942674197
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JENNIFER D LUCKIE O.D.

Provider Business Mailing Address
First Line	:	7910 RICHMOND HWY
Second Line	:
City	:	ALEXANDRIA
State	:	VA
Zip	:	22306-7826
Country	:	US
Telephone Number	:	703-780-7324
Fax Number	:

Provider Business Practice Location Address
First Line	:	1016 16TH ST NW BSMT LL
Second Line	:
City	:	WASHINGTON
State	:	DC
Zip	:	20036-5729
Country	:	US
Telephone Number	:	301-215-7100
Fax Number	:	202-452-1415

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

Provider Enumeration Date	:	11/25/2015
Last Update Date	:	07/21/2022

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