Provider Demographics
NPI:1083305569
Name:ALBERNAZ REGGIANI, LUCA (OD)
Entity Type:Individual
Prefix:
First Name:LUCA
Middle Name:
Last Name:ALBERNAZ REGGIANI
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:161 W 200 N STE 200
Mailing Address - Street 2:
Mailing Address - City:ST GEORGE
Mailing Address - State:UT
Mailing Address - Zip Code:84770-7386
Mailing Address - Country:US
Mailing Address - Phone:435-986-2020
Mailing Address - Fax:
Practice Address - Street 1:161 W 200 N STE 200
Practice Address - Street 2:
Practice Address - City:ST GEORGE
Practice Address - State:UT
Practice Address - Zip Code:84770-7386
Practice Address - Country:US
Practice Address - Phone:435-986-2020
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-05-16
Last Update Date:2023-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT13364197-9934152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist