Provider Demographics
NPI:1528589447
Name:LUCAS, KATELYN MARIE (OD)
Entity Type:Individual
Prefix:DR
First Name:KATELYN
Middle Name:MARIE
Last Name:LUCAS
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:KATELYN
Other - Middle Name:
Other - Last Name:SODER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:9002 N MERIDIAN ST
Mailing Address - Street 2:STE 100
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46260-2301
Mailing Address - Country:US
Mailing Address - Phone:317-844-5530
Mailing Address - Fax:317-844-5590
Practice Address - Street 1:9002 N MERIDIAN ST STE 100
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46260
Practice Address - Country:US
Practice Address - Phone:317-844-5530
Practice Address - Fax:317-844-5590
Is Sole Proprietor?:No
Enumeration Date:2017-06-30
Last Update Date:2018-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN18004056A152WC0802X, 152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
No152WC0802XEye and Vision Services ProvidersOptometristCorneal and Contact Management