Provider Demographics
NPI:1164710612
Name:LUCKEY, DAYNA ROSE (OD)
Entity Type:Individual
Prefix:
First Name:DAYNA
Middle Name:ROSE
Last Name:LUCKEY
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:DAYNA
Other - Middle Name:ROSE
Other - Last Name:HELVICK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OD
Mailing Address - Street 1:3000 C G ZINN RD
Mailing Address - Street 2:
Mailing Address - City:THORNDALE
Mailing Address - State:PA
Mailing Address - Zip Code:19372-1134
Mailing Address - Country:US
Mailing Address - Phone:610-384-9100
Mailing Address - Fax:610-384-3937
Practice Address - Street 1:3000 C G ZINN RD
Practice Address - Street 2:
Practice Address - City:THORNDALE
Practice Address - State:PA
Practice Address - Zip Code:19372-1134
Practice Address - Country:US
Practice Address - Phone:610-384-9100
Practice Address - Fax:610-384-3937
Is Sole Proprietor?:No
Enumeration Date:2011-07-19
Last Update Date:2016-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOEG002511152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA12252253OtherCAQH PROVIDER ID