Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 152W00000X | Optometrist | 2610000 | MN |
N | 152WC0802X | Optomitrist - Corneal and Contact Lenses | 2610000 | MN |
N | 152WP0200X | Pediatric Optomitrist | 2610000 | MN |
N | 152WS0006X | Sports Vision | 2610000 | MN |
N | 152WV0400X | Optomitrist - Vision Therapist | 2610000 | MN |
N | 152WX0102X | Occupational Vision | 2610000 | MN |
NPI | 1043309495 |
---|---|
Provider Name | Steven Jay Lusch |
First Address | Eagan, MN 55123-2324 |
Second Address | Eagan, MN 55123-2324 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 12/10/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
07G83LU | BLUE CROSS BLUE SHIELD (01) | MN |
116890 | UCARE (01) | MN |
2207362 | MEDICA (01) | MN |
811730 | AMERICAS PPO (01) | |
HP26612 | HEALTH PARTNERS (01) | MN |
ML1108782 | DEA (01) | |
U66285 | (02) | |
XX1901013483 | PREFERRED ONE (01) | MN |