Provider Demographics
NPI:1942205976
Name:LUCHANKO-GANLY, CAROL ANNE B (OD)
Entity Type:Individual
Prefix:DR
First Name:CAROL ANNE
Middle Name:B
Last Name:LUCHANKO-GANLY
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 1:109 HILLSIDE LN
Mailing Address - Street 2:
Mailing Address - City:KENNETT SQUARE
Mailing Address - State:PA
Mailing Address - Zip Code:19348-2267
Mailing Address - Country:US
Mailing Address - Phone:610-444-6703
Mailing Address - Fax:
Practice Address - Street 1:402 BAYARD RD
Practice Address - Street 2:SUITE 200
Practice Address - City:KENNETT SQUARE
Practice Address - State:PA
Practice Address - Zip Code:19348-1862
Practice Address - Country:US
Practice Address - Phone:484-770-8132
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-16
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOEG000361152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAOEG000361OtherSTATE OPTOMETRY LICENSE
PA481772OtherAETNA PROVIDER ID
PA481772OtherAETNA PROVIDER ID
PAML0401909OtherDEA NUMBER
PAU50754Medicare UPIN