Provider Demographics
NPI:1023121498
Name:LUTHER, JEFFREY WAYNE (OD)
Entity type:Individual
Prefix:DR
First Name:JEFFREY
Middle Name:WAYNE
Last Name:LUTHER
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2020 BLUE MESA CT
Mailing Address - Street 2:
Mailing Address - City:LOVELAND
Mailing Address - State:CO
Mailing Address - Zip Code:80538-4188
Mailing Address - Country:US
Mailing Address - Phone:970-663-4800
Mailing Address - Fax:970-663-0295
Practice Address - Street 1:2020 BLUE MESA CT
Practice Address - Street 2:
Practice Address - City:LOVELAND
Practice Address - State:CO
Practice Address - Zip Code:80538-4188
Practice Address - Country:US
Practice Address - Phone:970-663-4800
Practice Address - Fax:970-663-0295
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO2127152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO12606073Medicaid
COC444008Medicare ID - Type Unspecified
COU83366Medicare UPIN