Provider Demographics
NPI:1891754933
Name:LUEKENGA, RICHARD L SR (OD)
Entity Type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:L
Last Name:LUEKENGA
Suffix:SR
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 1:145 N 100 E
Mailing Address - Street 2:
Mailing Address - City:RICHFIELD
Mailing Address - State:UT
Mailing Address - Zip Code:84701-2131
Mailing Address - Country:US
Mailing Address - Phone:435-896-8142
Mailing Address - Fax:435-896-9484
Practice Address - Street 1:145 N 100 E
Practice Address - Street 2:
Practice Address - City:RICHFIELD
Practice Address - State:UT
Practice Address - Zip Code:84701-2131
Practice Address - Country:US
Practice Address - Phone:435-896-8142
Practice Address - Fax:435-896-9484
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-18
Last Update Date:2009-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT109811-9934152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
UTT78167Medicare UPIN
UT000009721Medicare ID - Type Unspecified