Provider Demographics
NPI:1336297746
Name:LUKER, LINDSAY (OD)
Entity Type:Individual
Prefix:
First Name:LINDSAY
Middle Name:
Last Name:LUKER
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4740 N LINCOLN AVE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60625-2247
Mailing Address - Country:US
Mailing Address - Phone:773-275-2900
Mailing Address - Fax:
Practice Address - Street 1:4740 N. LINCOLN AVE.
Practice Address - Street 2:SPEX
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60610
Practice Address - Country:US
Practice Address - Phone:773-275-2900
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-08
Last Update Date:2014-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL046-009758152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL1636706OtherBLUE CROSS BLUE SHIELD
IL7235044OtherAETNA
IL8825444OtherMULTIPLAN
IL211019Medicare PIN
IL7235044OtherAETNA