Provider Demographics
NPI:1841335189
Name:LUCERO, JUAN M (OD)
Entity type:Individual
Prefix:
First Name:JUAN
Middle Name:M
Last Name:LUCERO
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 1:301 N SOLANO DR STE 3
Mailing Address - Street 2:
Mailing Address - City:LAS CRUCES
Mailing Address - State:NM
Mailing Address - Zip Code:88001-2900
Mailing Address - Country:US
Mailing Address - Phone:505-541-1075
Mailing Address - Fax:
Practice Address - Street 1:301 N SOLANO DR STE 3
Practice Address - Street 2:
Practice Address - City:LAS CRUCES
Practice Address - State:NM
Practice Address - Zip Code:88001-2900
Practice Address - Country:US
Practice Address - Phone:505-541-1075
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM313152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist