Provider Demographics
NPI:1134316086
Name:LUCKY EYE CARE, PLLC
Entity Type:Organization
Organization Name:LUCKY EYE CARE, PLLC
Other - Org Name:MALINDA LUCKY FLORES, OD
Other - Org Type:Other Name
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MALINDA
Authorized Official - Middle Name:LUCKY
Authorized Official - Last Name:FLORES
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:304-375-4748
Mailing Address - Street 1:37 ALEXANDER DR
Mailing Address - Street 2:
Mailing Address - City:WILLIAMSTOWN
Mailing Address - State:WV
Mailing Address - Zip Code:26187-8302
Mailing Address - Country:US
Mailing Address - Phone:304-375-4748
Mailing Address - Fax:
Practice Address - Street 1:123 WEST WAGNER
Practice Address - Street 2:
Practice Address - City:ELLENBORO
Practice Address - State:WV
Practice Address - Zip Code:26346
Practice Address - Country:US
Practice Address - Phone:304-869-3028
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-25
Last Update Date:2008-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV951-OD152W00000X
WVWV 951-OD332H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
No332H00000XSuppliersEyewear SupplierGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV410044882OtherRAILROAD MEDICARE
WV001711137OtherBCBS
WV001711137OtherBCBS
WV410044882OtherRAILROAD MEDICARE
WVLU4042442Medicare PIN
WVLU4042441Medicare PIN