Provider Demographics
NPI:1376675777
Name:LAUCK, DENNIS P (OD)
Entity Type:Individual
Prefix:DR
First Name:DENNIS
Middle Name:P
Last Name:LAUCK
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 1:30 1ST ST SW
Mailing Address - Street 2:
Mailing Address - City:CARMEL
Mailing Address - State:IN
Mailing Address - Zip Code:46032-2102
Mailing Address - Country:US
Mailing Address - Phone:317-848-9081
Mailing Address - Fax:317-848-9083
Practice Address - Street 1:30 1ST ST SW
Practice Address - Street 2:
Practice Address - City:CARMEL
Practice Address - State:IN
Practice Address - Zip Code:46032-2102
Practice Address - Country:US
Practice Address - Phone:317-848-9081
Practice Address - Fax:317-848-9083
Is Sole Proprietor?:No
Enumeration Date:2007-03-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ININ18002012152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
INT35100Medicare UPIN