Provider Demographics
NPI:1639621444
Name:LUTCHMAN, JENELLA DHEA (OD)
Entity Type:Individual
Prefix:DR
First Name:JENELLA
Middle Name:DHEA
Last Name:LUTCHMAN
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 1:4927 MAIN ST
Mailing Address - Street 2:SUITE 300
Mailing Address - City:AMHERST
Mailing Address - State:NY
Mailing Address - Zip Code:14226-4081
Mailing Address - Country:US
Mailing Address - Phone:716-839-1780
Mailing Address - Fax:
Practice Address - Street 1:4927 MAIN ST
Practice Address - Street 2:SUITE 300
Practice Address - City:AMHERST
Practice Address - State:NY
Practice Address - Zip Code:14226-4081
Practice Address - Country:US
Practice Address - Phone:716-839-1780
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-10-27
Last Update Date:2016-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY008515152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist