Provider Demographics
NPI:1689902272
Name:DAMIAN LUE, O.D., P.A.
Entity Type:Organization
Organization Name:DAMIAN LUE, O.D., P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DAMIAN
Authorized Official - Middle Name:FRANCIS
Authorized Official - Last Name:LUE
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:305-558-4326
Mailing Address - Street 1:5851 NW 177TH ST
Mailing Address - Street 2:
Mailing Address - City:HIALEAH
Mailing Address - State:FL
Mailing Address - Zip Code:33015-5127
Mailing Address - Country:US
Mailing Address - Phone:305-558-4326
Mailing Address - Fax:305-826-2841
Practice Address - Street 1:5851 NW 177TH ST
Practice Address - Street 2:
Practice Address - City:HIALEAH
Practice Address - State:FL
Practice Address - Zip Code:33015-5127
Practice Address - Country:US
Practice Address - Phone:305-558-4326
Practice Address - Fax:305-826-2841
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-11-19
Last Update Date:2009-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOPC3021152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL620227600Medicaid