Provider Demographics
NPI:1760176077
Name:PAGE, LUKE DAVID (OD)
Entity Type:Individual
Prefix:DR
First Name:LUKE
Middle Name:DAVID
Last Name:PAGE
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 1:3222 MAJESTIC OAK CIR
Mailing Address - Street 2:
Mailing Address - City:COTTONWOOD
Mailing Address - State:CA
Mailing Address - Zip Code:96022-9568
Mailing Address - Country:US
Mailing Address - Phone:530-366-6303
Mailing Address - Fax:
Practice Address - Street 1:2770 EUREKA WAY STE 100
Practice Address - Street 2:
Practice Address - City:REDDING
Practice Address - State:CA
Practice Address - Zip Code:96001-0252
Practice Address - Country:US
Practice Address - Phone:530-222-7271
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-06-08
Last Update Date:2023-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA35510152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist