Provider Demographics
NPI:1124595368
Name:LUCENT OPTOMETRY MONTCLAIR INC
Entity Type:Organization
Organization Name:LUCENT OPTOMETRY MONTCLAIR INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:JESSIKA
Authorized Official - Middle Name:
Authorized Official - Last Name:BENJAMIN
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:909-788-3433
Mailing Address - Street 1:5544 SORIANO WAY
Mailing Address - Street 2:
Mailing Address - City:FONTANA
Mailing Address - State:CA
Mailing Address - Zip Code:92336-5955
Mailing Address - Country:US
Mailing Address - Phone:909-519-7155
Mailing Address - Fax:
Practice Address - Street 1:471 N CENTRAL AVE
Practice Address - Street 2:
Practice Address - City:UPLAND
Practice Address - State:CA
Practice Address - Zip Code:91786-4219
Practice Address - Country:US
Practice Address - Phone:909-788-3433
Practice Address - Fax:099-129-8096
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-10-25
Last Update Date:2023-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty