Provider Demographics
NPI:1083438303
Name:LUX, OLIVIA ANN (OD)
Entity type:Individual
Prefix:MRS
First Name:OLIVIA
Middle Name:ANN
Last Name:LUX
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2248 S WELLS ST
Mailing Address - Street 2:
Mailing Address - City:VALLONIA
Mailing Address - State:IN
Mailing Address - Zip Code:47281-9704
Mailing Address - Country:US
Mailing Address - Phone:812-583-5483
Mailing Address - Fax:
Practice Address - Street 1:401 HENRY ST
Practice Address - Street 2:
Practice Address - City:NORTH VERNON
Practice Address - State:IN
Practice Address - Zip Code:47265-1003
Practice Address - Country:US
Practice Address - Phone:812-346-2020
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-11-13
Last Update Date:2024-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN18004541A152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist