Provider Demographics
NPI:1841800018
Name:LUMINOPTIX OPTOMETRY
Entity Type:Organization
Organization Name:LUMINOPTIX OPTOMETRY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPTOMETRIST
Authorized Official - Prefix:DR
Authorized Official - First Name:KATHRYN
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:RECKER
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:714-420-3806
Mailing Address - Street 1:655 SATURN BLVD STE H
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92154-4734
Mailing Address - Country:US
Mailing Address - Phone:619-425-9001
Mailing Address - Fax:
Practice Address - Street 1:655 SATURN BLVD STE H
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92154-4734
Practice Address - Country:US
Practice Address - Phone:619-425-9001
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-08-03
Last Update Date:2021-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty