Provider Demographics
NPI:1619192846
Name:LUSK, MARCIA LYNN (OD)
Entity Type:Individual
Prefix:DR
First Name:MARCIA
Middle Name:LYNN
Last Name:LUSK
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:777 E MERRITT ISLAND CSWY
Mailing Address - Street 2:SUITE 200A
Mailing Address - City:MERRITT ISLAND
Mailing Address - State:FL
Mailing Address - Zip Code:32952-3576
Mailing Address - Country:US
Mailing Address - Phone:321-454-9909
Mailing Address - Fax:
Practice Address - Street 1:777 E MERRITT ISLAND CSWY
Practice Address - Street 2:SUITE 200A
Practice Address - City:MERRITT ISLAND
Practice Address - State:FL
Practice Address - Zip Code:32952-3576
Practice Address - Country:US
Practice Address - Phone:321-454-9909
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOPC 3601152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL922137OtherEYEMED PROVIDER NUMBER