Provider Demographics
NPI:1841326535
Name:LUCAS, TODD NICHOLES (OD)
Entity type:Individual
Prefix:DR
First Name:TODD
Middle Name:NICHOLES
Last Name:LUCAS
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3165 S GRAND BLVD
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63118-1021
Mailing Address - Country:US
Mailing Address - Phone:314-772-3737
Mailing Address - Fax:314-664-7722
Practice Address - Street 1:3165 S GRAND BLVD
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63118-1021
Practice Address - Country:US
Practice Address - Phone:314-772-3737
Practice Address - Fax:314-664-7722
Is Sole Proprietor?:No
Enumeration Date:2007-02-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOT02570152W00000X, 152WC0802X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered152W00000XEye and Vision Services ProvidersOptometrist
Not Answered152WC0802XEye and Vision Services ProvidersOptometristCorneal and Contact Management
Provider Identifiers
StateIdentifier IDID TypeIssuer
MOT42701Medicare UPIN