Provider Demographics
NPI:1790917722
Name:LUCAS, LAUREN GREENE (OD)
Entity Type:Individual
Prefix:DR
First Name:LAUREN
Middle Name:GREENE
Last Name:LUCAS
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:8900 WEST BROAD STREET
Mailing Address - Street 2:SUITE C
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23294-5815
Mailing Address - Country:US
Mailing Address - Phone:804-270-6030
Mailing Address - Fax:804-270-4150
Practice Address - Street 1:8900 WEST BROAD STREET
Practice Address - Street 2:SUITE C
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23294-5815
Practice Address - Country:US
Practice Address - Phone:804-270-6030
Practice Address - Fax:804-270-4150
Is Sole Proprietor?:No
Enumeration Date:2009-08-09
Last Update Date:2015-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0618001866152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA0618001866OtherVA OPTOMETRY LICENSE