Provider Demographics
NPI:1932438025
Name:JEFFREY L LUTY OD, PA
Entity Type:Organization
Organization Name:JEFFREY L LUTY OD, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:L
Authorized Official - Last Name:LUTY
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:785-263-3651
Mailing Address - Street 1:1000 N BROWN ST STE A
Mailing Address - Street 2:
Mailing Address - City:ABILENE
Mailing Address - State:KS
Mailing Address - Zip Code:67410-1824
Mailing Address - Country:US
Mailing Address - Phone:785-263-3651
Mailing Address - Fax:785-263-3561
Practice Address - Street 1:1000 N BROWN ST STE A
Practice Address - Street 2:
Practice Address - City:ABILENE
Practice Address - State:KS
Practice Address - Zip Code:67410-1824
Practice Address - Country:US
Practice Address - Phone:785-263-3651
Practice Address - Fax:785-263-3561
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-12-18
Last Update Date:2011-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS100220010BMedicaid
KS650851Medicare PIN
KS100220010BMedicaid
KS4189160001Medicare NSC