Provider Demographics
NPI:1942399456
Name:LUEHMANN, VICKI SUE (OD)
Entity Type:Individual
Prefix:DR
First Name:VICKI
Middle Name:SUE
Last Name:LUEHMANN
Suffix:
Gender:F
Credentials:OD
Other - Prefix:DR
Other - First Name:VICKI
Other - Middle Name:SUE
Other - Last Name:BOROWICZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OD
Mailing Address - Street 1:223 1ST ST E
Mailing Address - Street 2:SUITE 101
Mailing Address - City:JORDAN
Mailing Address - State:MN
Mailing Address - Zip Code:55352-1561
Mailing Address - Country:US
Mailing Address - Phone:952-492-2350
Mailing Address - Fax:952-492-6162
Practice Address - Street 1:223 1ST ST E
Practice Address - Street 2:SUITE 101
Practice Address - City:JORDAN
Practice Address - State:MN
Practice Address - Zip Code:55352-1561
Practice Address - Country:US
Practice Address - Phone:952-492-2350
Practice Address - Fax:952-492-6162
Is Sole Proprietor?:No
Enumeration Date:2006-10-12
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN2848000152W00000X, 152WC0802X, 152WP0200X, 152WS0006X, 152WX0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
No152WC0802XEye and Vision Services ProvidersOptometristCorneal and Contact Management
No152WP0200XEye and Vision Services ProvidersOptometristPediatrics
No152WS0006XEye and Vision Services ProvidersOptometristSports Vision
No152WX0102XEye and Vision Services ProvidersOptometristOccupational Vision
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN2201857OtherMEDICA
MN51M08BOOtherBLUE CROSS BLUE SHIELD
MN1725622OtherAMERICAS PPO
MNHP29343OtherHEALTH PARTNERS
MNXX1901032963OtherPREFERRED ONE
MN132580900Medicaid
MN142943OtherUCARE
MN142943OtherUCARE
MN410001828Medicare ID - Type Unspecified
MN132580900Medicaid
MNXX1901032963OtherPREFERRED ONE