Provider Demographics
NPI:1710098835
Name:LUCKHARDT, CHARLES F II (MED,CPO,LPO)
Entity Type:Individual
Prefix:MR
First Name:CHARLES
Middle Name:F
Last Name:LUCKHARDT
Suffix:II
Gender:M
Credentials:MED,CPO,LPO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1411 NW 23RD AVE
Mailing Address - Street 2:
Mailing Address - City:CHIEFLAND
Mailing Address - State:FL
Mailing Address - Zip Code:32626-1976
Mailing Address - Country:US
Mailing Address - Phone:352-493-0360
Mailing Address - Fax:352-493-0369
Practice Address - Street 1:1411 NW 23RD AVE
Practice Address - Street 2:
Practice Address - City:CHIEFLAND
Practice Address - State:FL
Practice Address - Zip Code:32626-1976
Practice Address - Country:US
Practice Address - Phone:352-493-0360
Practice Address - Fax:352-493-0369
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-31
Last Update Date:2010-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPOR92222Z00000X, 224P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes222Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOrthotist
No224P00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersProsthetist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL0716130001Medicare ID - Type Unspecified