Provider Demographics
NPI:1467444190
Name:LUKE PROSTHETIC AND ORTHOTIC LAB, INC.
Entity Type:Organization
Organization Name:LUKE PROSTHETIC AND ORTHOTIC LAB, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER, PROSTHETIC
Authorized Official - Prefix:MR
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:ALAN
Authorized Official - Last Name:LUKE
Authorized Official - Suffix:
Authorized Official - Credentials:CPO
Authorized Official - Phone:740-993-0066
Mailing Address - Street 1:117 E WALLACE ST
Mailing Address - Street 2:
Mailing Address - City:FINDLAY
Mailing Address - State:OH
Mailing Address - Zip Code:45840-5219
Mailing Address - Country:US
Mailing Address - Phone:419-422-5009
Mailing Address - Fax:419-422-6766
Practice Address - Street 1:315 E FOULKE AVE
Practice Address - Street 2:
Practice Address - City:FINDLAY
Practice Address - State:OH
Practice Address - Zip Code:45840-4619
Practice Address - Country:US
Practice Address - Phone:740-993-0066
Practice Address - Fax:419-664-4629
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-08-18
Last Update Date:2021-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHLP-0069335E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH000000247835OtherANTHEM BCBS
OH2333808Medicaid
OH283749811-00OtherBWC
OH2333808Medicaid
OH000000247835OtherANTHEM BCBS