Provider Demographics
NPI:1457618290
Name:STEPHEN A. LUSKIN OPTOMETRIC CORPORATION
Entity Type:Organization
Organization Name:STEPHEN A. LUSKIN OPTOMETRIC CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPTOMETRIST
Authorized Official - Prefix:DR
Authorized Official - First Name:STEPHEN
Authorized Official - Middle Name:ARNOLD
Authorized Official - Last Name:LUSKIN
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:619-246-4505
Mailing Address - Street 1:1259 EMERALD ST.
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92109-2932
Mailing Address - Country:US
Mailing Address - Phone:619-246-4505
Mailing Address - Fax:858-272-0575
Practice Address - Street 1:1259 EMERALD ST.
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92109-2932
Practice Address - Country:US
Practice Address - Phone:619-246-4505
Practice Address - Fax:858-272-0575
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-04-18
Last Update Date:2012-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA69957152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
U28572Medicare UPIN
SD0069950Medicare PIN