Provider Demographics
NPI:1386202109
Name:LUX EYE CARE STUDIO OPTOMETRY PC
Entity Type:Organization
Organization Name:LUX EYE CARE STUDIO OPTOMETRY PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:TRACY
Authorized Official - Middle Name:
Authorized Official - Last Name:BROOKS
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:631-546-0665
Mailing Address - Street 1:16 SPRINGBRIAR LN
Mailing Address - Street 2:
Mailing Address - City:KINGS PARK
Mailing Address - State:NY
Mailing Address - Zip Code:11754-5031
Mailing Address - Country:US
Mailing Address - Phone:516-456-2268
Mailing Address - Fax:
Practice Address - Street 1:1946 JERICHO TPKE
Practice Address - Street 2:
Practice Address - City:EAST NORTHPORT
Practice Address - State:NY
Practice Address - Zip Code:11731-6207
Practice Address - Country:US
Practice Address - Phone:631-546-0665
Practice Address - Fax:631-546-0404
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-06-05
Last Update Date:2019-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty