Provider Demographics
NPI:1184826703
Name:LUX ORTHOTICS, INC
Entity Type:Organization
Organization Name:LUX ORTHOTICS, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:V
Authorized Official - Last Name:LUX
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:417-624-2332
Mailing Address - Street 1:1307 W 20TH ST
Mailing Address - Street 2:
Mailing Address - City:JOPLIN
Mailing Address - State:MO
Mailing Address - Zip Code:64804-1700
Mailing Address - Country:US
Mailing Address - Phone:417-624-2332
Mailing Address - Fax:417-624-0599
Practice Address - Street 1:1307 W 20TH ST
Practice Address - Street 2:
Practice Address - City:JOPLIN
Practice Address - State:MO
Practice Address - Zip Code:64804-1700
Practice Address - Country:US
Practice Address - Phone:417-624-2332
Practice Address - Fax:417-624-0599
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-05
Last Update Date:2017-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO106787OtherDME
OK100795140AMedicaid
MO628632002Medicaid
MO113880001Medicare NSC