Provider Demographics
NPI:1659437796
Name:LUKAS, STEPHEN P (OPTICIAN)
Entity Type:Individual
Prefix:MR
First Name:STEPHEN
Middle Name:P
Last Name:LUKAS
Suffix:
Gender:M
Credentials:OPTICIAN
Other - Prefix:
Other - First Name:
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Other - Credentials:
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:313-388-9461
Mailing Address - Fax:313-388-1639
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:313-388-1639
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-30
Last Update Date:2008-02-06
Deactivation Date:
Deactivation Code:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0903410001Medicare NSC