Provider Demographics
NPI:1295878072
Name:LUCHKA, TIM (OPA-C, SA-C)
Entity type:Individual
Prefix:
First Name:TIM
Middle Name:
Last Name:LUCHKA
Suffix:
Gender:M
Credentials:OPA-C, SA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4031 W PLANO PKWY STE 100
Mailing Address - Street 2:
Mailing Address - City:PLANO
Mailing Address - State:TX
Mailing Address - Zip Code:75093-5617
Mailing Address - Country:US
Mailing Address - Phone:972-985-1072
Mailing Address - Fax:972-964-3469
Practice Address - Street 1:4031 W PLANO PKWY STE 100
Practice Address - Street 2:
Practice Address - City:PLANO
Practice Address - State:TX
Practice Address - Zip Code:75093-5617
Practice Address - Country:US
Practice Address - Phone:972-985-1072
Practice Address - Fax:972-964-3469
Is Sole Proprietor?:No
Enumeration Date:2007-02-14
Last Update Date:2013-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246ZC0007XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherSurgical Assistant