Provider Demographics
NPI:1356638761
Name:LUKE, SPENCER KEVIN (OD)
Entity Type:Individual
Prefix:DR
First Name:SPENCER
Middle Name:KEVIN
Last Name:LUKE
Suffix:
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 1:10709 S WALTON RD
Mailing Address - Street 2:
Mailing Address - City:LA GRANDE
Mailing Address - State:OR
Mailing Address - Zip Code:97850-8490
Mailing Address - Country:US
Mailing Address - Phone:541-962-7753
Mailing Address - Fax:
Practice Address - Street 1:10709 S WALTON RD
Practice Address - Street 2:
Practice Address - City:LA GRANDE
Practice Address - State:OR
Practice Address - Zip Code:97850-8490
Practice Address - Country:US
Practice Address - Phone:541-962-7753
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-07-06
Last Update Date:2011-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT8024988-9934152W00000X
OR3427ATI152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist