Provider Demographics
NPI:1154476455
Name:LUCAS, TIMOTHY MICHAEL (O D)
Entity Type:Individual
Prefix:DR
First Name:TIMOTHY
Middle Name:MICHAEL
Last Name:LUCAS
Suffix:
Gender:M
Credentials:O D
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:15933 CLAYTON RD STE 201
Mailing Address - Street 2:
Mailing Address - City:BALLWIN
Mailing Address - State:MO
Mailing Address - Zip Code:63011-2172
Mailing Address - Country:US
Mailing Address - Phone:636-200-4393
Mailing Address - Fax:636-527-0766
Practice Address - Street 1:4109 UNION RD
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63129-1064
Practice Address - Country:US
Practice Address - Phone:314-487-0700
Practice Address - Fax:314-487-1212
Is Sole Proprietor?:No
Enumeration Date:2007-01-24
Last Update Date:2016-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOTO2350152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO2202044OtherUNITED HEALTHCARE
MO5268423OtherCIGNA HEALTHCARE
MO208725OtherHEALTHLINK
MO32313OtherANTHEM BLUE CROSS BLUE SH
MO53491OtherGROUP HEALTH PLAN
MO208725OtherHEALTHLINK
MO5268423OtherCIGNA HEALTHCARE