Provider Demographics
NPI:1629630579
Name:LUTHER, LYDIA KATE (OD)
Entity Type:Individual
Prefix:DR
First Name:LYDIA
Middle Name:KATE
Last Name:LUTHER
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 1:1515 9TH AVE N
Mailing Address - Street 2:
Mailing Address - City:ST PETERSBURG
Mailing Address - State:FL
Mailing Address - Zip Code:33705-1224
Mailing Address - Country:US
Mailing Address - Phone:727-895-2020
Mailing Address - Fax:727-823-8796
Practice Address - Street 1:6036 PARK BLVD N
Practice Address - Street 2:
Practice Address - City:PINELLAS PARK
Practice Address - State:FL
Practice Address - Zip Code:33781-3228
Practice Address - Country:US
Practice Address - Phone:727-895-2020
Practice Address - Fax:727-823-8796
Is Sole Proprietor?:No
Enumeration Date:2019-07-01
Last Update Date:2021-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOPC005707152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL103786100Medicaid