Provider Demographics
NPI:1811044506
Name:LUCAS, CYNTHIA JEAN (OD)
Entity Type:Individual
Prefix:DR
First Name:CYNTHIA
Middle Name:JEAN
Last Name:LUCAS
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:118 RAMSEY LN
Mailing Address - Street 2:
Mailing Address - City:BALLWIN
Mailing Address - State:MO
Mailing Address - Zip Code:63021-4910
Mailing Address - Country:US
Mailing Address - Phone:636-227-5524
Mailing Address - Fax:636-227-9134
Practice Address - Street 1:118 RAMSEY LN
Practice Address - Street 2:
Practice Address - City:BALLWIN
Practice Address - State:MO
Practice Address - Zip Code:63021-4910
Practice Address - Country:US
Practice Address - Phone:636-227-5524
Practice Address - Fax:636-227-9134
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-04
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOTO-3419152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO16639OtherBUREAU OF NARCOTICS #
MOTO-3419OtherSTATE LICENSE
MOTO-3419OtherSTATE LICENSE
MO16639OtherBUREAU OF NARCOTICS #
MOML0431154OtherDEA #