Provider Demographics
NPI:1760459358
Name:LUEKENGA, AARON MEADOR (OD)
Entity Type:Individual
Prefix:DR
First Name:AARON
Middle Name:MEADOR
Last Name:LUEKENGA
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 1:400 E SANTA BARBARA ST
Mailing Address - Street 2:SUITE C
Mailing Address - City:SANTA PAULA
Mailing Address - State:CA
Mailing Address - Zip Code:93060-2675
Mailing Address - Country:US
Mailing Address - Phone:805-525-6603
Mailing Address - Fax:805-525-6115
Practice Address - Street 1:400 E SANTA BARBARA ST
Practice Address - Street 2:SUITE C
Practice Address - City:SANTA PAULA
Practice Address - State:CA
Practice Address - Zip Code:93060-2675
Practice Address - Country:US
Practice Address - Phone:805-525-6603
Practice Address - Fax:805-525-6115
Is Sole Proprietor?:No
Enumeration Date:2006-03-02
Last Update Date:2010-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA11919T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAWOP11919BMedicare ID - Type Unspecified
CAWOP11919AMedicare ID - Type Unspecified
V08167Medicare UPIN