Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 152W00000X | Optometrist | 0601001619 | VA |
Y | 152W00000X | Optometrist | TA1029 | MD |
NPI | 1003973538 |
---|---|
Provider Name | Perry J Lucente |
First Address | Davidsonville, MD 21035 |
Second Address | Davidsonville, MD 21035 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 03/01/2007 |
Last Update Date | 14/03/2010 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
650898700 | (05) | MD |
656342 | MEDICARE (01) | DC |
656342 | MEDICARE (01) | MD |
U12195 | (02) |