Provider Demographics
NPI:1780017483
Name:PREVIL, LUCKSON (OD)
Entity Type:Individual
Prefix:DR
First Name:LUCKSON
Middle Name:
Last Name:PREVIL
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:341 COOL SPRINGS BLVD.
Mailing Address - Street 2:STE. 400
Mailing Address - City:FRANKLIN
Mailing Address - State:TN
Mailing Address - Zip Code:37067
Mailing Address - Country:US
Mailing Address - Phone:423-508-7337
Mailing Address - Fax:423-508-7338
Practice Address - Street 1:7268 JARNIGAN RD
Practice Address - Street 2:SUITE 200
Practice Address - City:CHATTANOOGA
Practice Address - State:TN
Practice Address - Zip Code:37421-3097
Practice Address - Country:US
Practice Address - Phone:423-508-7337
Practice Address - Fax:423-508-7338
Is Sole Proprietor?:No
Enumeration Date:2013-08-16
Last Update Date:2023-02-12
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TN3138152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist