Provider Demographics
NPI:1699821124
Name:LUU, TONY T (OD)
Entity Type:Individual
Prefix:
First Name:TONY
Middle Name:T
Last Name:LUU
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16172 AIRLINE HWY
Mailing Address - Street 2:SUITE A
Mailing Address - City:PRAIRIEVILLE
Mailing Address - State:LA
Mailing Address - Zip Code:70769-4212
Mailing Address - Country:US
Mailing Address - Phone:225-313-6820
Mailing Address - Fax:225-313-6231
Practice Address - Street 1:16172 AIRLINE HWY
Practice Address - Street 2:SUITE A
Practice Address - City:PRAIRIEVILLE
Practice Address - State:LA
Practice Address - Zip Code:70769-4212
Practice Address - Country:US
Practice Address - Phone:225-313-6820
Practice Address - Fax:225-313-6231
Is Sole Proprietor?:No
Enumeration Date:2007-01-26
Last Update Date:2013-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA1262416T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1136638Medicaid
90840Medicare UPIN
LA4B270Medicare PIN
LA1136638Medicaid