Provider Demographics
NPI:1326163205
Name:LUCAS, JERROLD JOSEPH JR (OD)
Entity Type:Individual
Prefix:
First Name:JERROLD
Middle Name:JOSEPH
Last Name:LUCAS
Suffix:JR
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 W FLATIRON CIR
Mailing Address - Street 2:SUITE 2052
Mailing Address - City:BROOMFIELD
Mailing Address - State:CO
Mailing Address - Zip Code:80021-8881
Mailing Address - Country:US
Mailing Address - Phone:720-887-6066
Mailing Address - Fax:
Practice Address - Street 1:1 W FLATIRON CIR
Practice Address - Street 2:SUITE 2052
Practice Address - City:BROOMFIELD
Practice Address - State:CO
Practice Address - Zip Code:80021-8881
Practice Address - Country:US
Practice Address - Phone:720-887-6066
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO1908152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist