Provider Demographics
NPI:1598732919
Name:LUKA, JANUSZ (OD)
Entity Type:Individual
Prefix:
First Name:JANUSZ
Middle Name:
Last Name:LUKA
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7843 YOUREE DR
Mailing Address - Street 2:
Mailing Address - City:SHREVEPORT
Mailing Address - State:LA
Mailing Address - Zip Code:71105-5505
Mailing Address - Country:US
Mailing Address - Phone:318-212-3937
Mailing Address - Fax:318-222-6414
Practice Address - Street 1:7843 YOUREE DR
Practice Address - Street 2:
Practice Address - City:SHREVEPORT
Practice Address - State:LA
Practice Address - Zip Code:71105-5505
Practice Address - Country:US
Practice Address - Phone:318-212-3937
Practice Address - Fax:318-212-3769
Is Sole Proprietor?:No
Enumeration Date:2006-03-03
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA1385-425T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1620416Medicaid
LA1385-425TOtherSTATE LIC #
LA1385-425TOtherSTATE LIC #
LAML0932031OtherDEA LIC #
LA1620416Medicaid