Provider Demographics
NPI:1942478045
Name:ANDREA L LUSK MD LLC
Entity Type:Organization
Organization Name:ANDREA L LUSK MD LLC
Other - Org Name:ANDREA L LUSK MD SOLE MBR
Other - Org Type:Other Name
Authorized Official - Title/Position:SOLE OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ANDREA
Authorized Official - Middle Name:L
Authorized Official - Last Name:LUSK
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:727-868-5875
Mailing Address - Street 1:1802 ISLEWORTH CT
Mailing Address - Street 2:
Mailing Address - City:OLDSMAR
Mailing Address - State:FL
Mailing Address - Zip Code:34677-4857
Mailing Address - Country:US
Mailing Address - Phone:727-868-5875
Mailing Address - Fax:727-489-9494
Practice Address - Street 1:11031 US HIGHWAY 19
Practice Address - Street 2:SUITE 106
Practice Address - City:PORT RICHEY
Practice Address - State:FL
Practice Address - Zip Code:34668-2213
Practice Address - Country:US
Practice Address - Phone:727-868-5875
Practice Address - Fax:727-489-9494
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-12
Last Update Date:2008-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME 85673207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty