Provider Demographics
NPI:1134575178
Name:LUMEN OPTICAL, LLC
Entity type:Organization
Organization Name:LUMEN OPTICAL, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRIVACY OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:HEATHER
Authorized Official - Middle Name:
Authorized Official - Last Name:ALLEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:801-316-5508
Mailing Address - Street 1:655 W GRAND AVE
Mailing Address - Street 2:UNIT 130
Mailing Address - City:ELMHURST
Mailing Address - State:IL
Mailing Address - Zip Code:60126-1060
Mailing Address - Country:US
Mailing Address - Phone:801-316-5508
Mailing Address - Fax:801-316-7529
Practice Address - Street 1:261 W DATA DR
Practice Address - Street 2:
Practice Address - City:DRAPER
Practice Address - State:UT
Practice Address - Zip Code:84020-2372
Practice Address - Country:US
Practice Address - Phone:801-316-5508
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-05-09
Last Update Date:2016-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty