Provider Demographics
NPI:1922291442
Name:GARY B. LUKES
Entity Type:Organization
Organization Name:GARY B. LUKES
Other - Org Name:VALLEY VIEW EYE CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:GARY
Authorized Official - Middle Name:
Authorized Official - Last Name:LUKES
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:715-778-5876
Mailing Address - Street 1:PO BOX 10
Mailing Address - Street 2:
Mailing Address - City:SPRING VALLEY
Mailing Address - State:WI
Mailing Address - Zip Code:54767-0010
Mailing Address - Country:US
Mailing Address - Phone:715-778-5876
Mailing Address - Fax:
Practice Address - Street 1:344 E EAU GALLE RD
Practice Address - Street 2:
Practice Address - City:SPRING VALLEY
Practice Address - State:WI
Practice Address - Zip Code:54767
Practice Address - Country:US
Practice Address - Phone:715-778-5876
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-20
Last Update Date:2010-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WIT62646Medicare UPIN