Provider Demographics
NPI:1528193570
Name:WILLIAM J. LUCK
Entity Type:Organization
Organization Name:WILLIAM J. LUCK
Other - Org Name:LUCK OPTICAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:J
Authorized Official - Last Name:LUCK
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:817-427-8002
Mailing Address - Street 1:7108 CAMP BOWIE BLVD
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76116-7121
Mailing Address - Country:US
Mailing Address - Phone:817-738-3191
Mailing Address - Fax:817-738-7724
Practice Address - Street 1:8401 BOULEVARD 26
Practice Address - Street 2:STE. 14
Practice Address - City:NORTH RICHLAND HILLS
Practice Address - State:TX
Practice Address - Zip Code:76180-5800
Practice Address - Country:US
Practice Address - Phone:817-427-8002
Practice Address - Fax:817-485-5998
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-22
Last Update Date:2010-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX2393152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX2393OtherTEXAS OPTOMETRY LICENSE