Provider Demographics
NPI:1245315274
Name:LUTSKY, LARRY (OPTICIAN)
Entity type:Individual
Prefix:
First Name:LARRY
Middle Name:
Last Name:LUTSKY
Suffix:
Gender:M
Credentials:OPTICIAN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13 STONEGATE DR
Mailing Address - Street 2:
Mailing Address - City:WATCHUNG
Mailing Address - State:NJ
Mailing Address - Zip Code:07069-5469
Mailing Address - Country:US
Mailing Address - Phone:908-625-8180
Mailing Address - Fax:
Practice Address - Street 1:2115 US HIGHWAY 22 W
Practice Address - Street 2:EYESTYLES
Practice Address - City:UNION
Practice Address - State:NJ
Practice Address - Zip Code:07083-8403
Practice Address - Country:US
Practice Address - Phone:908-851-0470
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJTD2103156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician