Provider Demographics
NPI:1912061078
Name:LUCAS, BRUCE J (OD)
Entity Type:Individual
Prefix:DR
First Name:BRUCE
Middle Name:J
Last Name:LUCAS
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Mailing Address - Street 1:20121 VENTURA BLVD STE 102
Mailing Address - Street 2:
Mailing Address - City:WOODLAND HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:91364-2558
Mailing Address - Country:US
Mailing Address - Phone:818-348-1266
Mailing Address - Fax:818-348-1280
Practice Address - Street 1:20121 VENTURA BLVD STE 102
Practice Address - Street 2:
Practice Address - City:WOODLAND HILLS
Practice Address - State:CA
Practice Address - Zip Code:91364-2558
Practice Address - Country:US
Practice Address - Phone:818-348-1266
Practice Address - Fax:818-348-1280
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA7841T152W00000X, 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
CAOP7841Medicare ID - Type Unspecified