Provider Demographics
NPI:1578735098
Name:STEPHEN LUKAS OPTICIAN
Entity Type:Organization
Organization Name:STEPHEN LUKAS OPTICIAN
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ASSISTANT
Authorized Official - Prefix:MRS
Authorized Official - First Name:NANCY
Authorized Official - Middle Name:
Authorized Official - Last Name:CLINTON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:313-388-9461
Mailing Address - Street 1:18235 WOOD ST
Mailing Address - Street 2:
Mailing Address - City:MELVINDALE
Mailing Address - State:MI
Mailing Address - Zip Code:48122-1432
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:18235 WOOD ST
Practice Address - Street 2:
Practice Address - City:MELVINDALE
Practice Address - State:MI
Practice Address - Zip Code:48122-1432
Practice Address - Country:US
Practice Address - Phone:313-388-9461
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-25
Last Update Date:2008-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332H00000XSuppliersEyewear Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0903410001Medicare NSC