Provider Demographics
NPI:1508863416
Name:LUCAS, HOWARD C (MD)
Entity Type:Individual
Prefix:
First Name:HOWARD
Middle Name:C
Last Name:LUCAS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:560 AVENUE K SE
Mailing Address - Street 2:WINTER HAVEN
Mailing Address - City:WINTER HAVEN
Mailing Address - State:FL
Mailing Address - Zip Code:33880-4203
Mailing Address - Country:US
Mailing Address - Phone:863-294-2450
Mailing Address - Fax:863-299-3982
Practice Address - Street 1:560 AVENUE K SE
Practice Address - Street 2:WINTER HAVEN
Practice Address - City:WINTER HAVEN
Practice Address - State:FL
Practice Address - Zip Code:33880-4203
Practice Address - Country:US
Practice Address - Phone:863-294-2450
Practice Address - Fax:863-299-3982
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-07
Last Update Date:2009-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME5476207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL045138000Medicaid
FL045138000Medicaid
FL53140Medicare ID - Type Unspecified