Provider Demographics
NPI:1104899038
Name:LUCIER, ALFRED C (MD)
Entity type:Individual
Prefix:DR
First Name:ALFRED
Middle Name:C
Last Name:LUCIER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:100 PRESIDENTIAL BLVD
Mailing Address - Street 2:SUITE 200
Mailing Address - City:BALA CYNWYD
Mailing Address - State:PA
Mailing Address - Zip Code:19004-1108
Mailing Address - Country:US
Mailing Address - Phone:610-660-0446
Mailing Address - Fax:610-660-0419
Practice Address - Street 1:100 PRESIDENTIAL BLVD
Practice Address - Street 2:SUITE 200
Practice Address - City:BALA CYNWYD
Practice Address - State:PA
Practice Address - Zip Code:19004-1108
Practice Address - Country:US
Practice Address - Phone:610-660-0446
Practice Address - Fax:610-660-0419
Is Sole Proprietor?:No
Enumeration Date:2006-02-10
Last Update Date:2009-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD009234E207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA102030226-0001Medicaid
PA102030226-0004Medicaid
PA000642120-0001Medicaid
PA000642120-0001Medicaid
PAB33413Medicare UPIN
PA180044881Medicare PIN
PA019610FVUMedicare PIN
PA102030226-0001Medicaid
PA019610ZCMMedicare PIN