Provider Demographics
NPI:1083805816
Name:HANEY, LUCAS GENE (OD)
Entity Type:Individual
Prefix:DR
First Name:LUCAS
Middle Name:GENE
Last Name:HANEY
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 1:2100 PERRYTON PKWY
Mailing Address - Street 2:
Mailing Address - City:PAMPA
Mailing Address - State:TX
Mailing Address - Zip Code:79065-3524
Mailing Address - Country:US
Mailing Address - Phone:806-486-1152
Mailing Address - Fax:
Practice Address - Street 1:2100 PERRYTON PKWY
Practice Address - Street 2:
Practice Address - City:PAMPA
Practice Address - State:TX
Practice Address - Zip Code:79065-3524
Practice Address - Country:US
Practice Address - Phone:806-486-1152
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-08-07
Last Update Date:2020-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX7065TG152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1910176-01Medicaid
TX1910192-01Medicaid