Provider Demographics
NPI:1154382208
Name:HUM, LUCAS GLENN (OD)
Entity type:Individual
Prefix:DR
First Name:LUCAS
Middle Name:GLENN
Last Name:HUM
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:2115 GREEN VISTA DR
Mailing Address - Street 2:STE 101
Mailing Address - City:SPARKS
Mailing Address - State:NV
Mailing Address - Zip Code:89431-8516
Mailing Address - Country:US
Mailing Address - Phone:775-359-2111
Mailing Address - Fax:775-673-6948
Practice Address - Street 1:2115 GREEN VISTA DR
Practice Address - Street 2:STE 101
Practice Address - City:SPARKS
Practice Address - State:NV
Practice Address - Zip Code:89431-8516
Practice Address - Country:US
Practice Address - Phone:775-359-2111
Practice Address - Fax:775-673-6948
Is Sole Proprietor?:No
Enumeration Date:2006-03-29
Last Update Date:2015-03-19
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NV202152W00000X
HI193152W00000X
CA7892152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NVCY266ZMedicare PIN