Provider Demographics
NPI:1942389945
Name:DRS LUCK & GOLDEN OPTOMETRISTS PC
Entity Type:Organization
Organization Name:DRS LUCK & GOLDEN OPTOMETRISTS PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ANDREW
Authorized Official - Middle Name:S
Authorized Official - Last Name:LUCK
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:315-866-4020
Mailing Address - Street 1:PO BOX 629
Mailing Address - Street 2:
Mailing Address - City:HERKIMER
Mailing Address - State:NY
Mailing Address - Zip Code:13350
Mailing Address - Country:US
Mailing Address - Phone:315-866-4020
Mailing Address - Fax:315-866-4026
Practice Address - Street 1:3079 STATE ROUTE 28
Practice Address - Street 2:
Practice Address - City:HERKIMER
Practice Address - State:NY
Practice Address - Zip Code:13350
Practice Address - Country:US
Practice Address - Phone:315-866-4020
Practice Address - Fax:315-866-4026
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-02
Last Update Date:2009-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY4163580001Medicare NSC
NYAA0909Medicare PIN