Provider Demographics
NPI:1952424772
Name:LUZON, VICENTE EMMANUEL (OD)
Entity type:Individual
Prefix:
First Name:VICENTE
Middle Name:EMMANUEL
Last Name:LUZON
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 1:311 ROUTE 9W
Mailing Address - Street 2:
Mailing Address - City:GLENMONT
Mailing Address - State:NY
Mailing Address - Zip Code:12077-2909
Mailing Address - Country:US
Mailing Address - Phone:518-432-0363
Mailing Address - Fax:
Practice Address - Street 1:311 ROUTE 9W
Practice Address - Street 2:
Practice Address - City:GLENMONT
Practice Address - State:NY
Practice Address - Zip Code:12077-2909
Practice Address - Country:US
Practice Address - Phone:518-432-0363
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-08
Last Update Date:2024-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYTUV-007006-1152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist