Provider Demographics
NPI:1194127233
Name:MCDANIEL, LAURA LUSK (OD)
Entity type:Individual
Prefix:DR
First Name:LAURA
Middle Name:LUSK
Last Name:MCDANIEL
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 1:77 PERIWINKLE LN
Mailing Address - Street 2:
Mailing Address - City:BURNSVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28714-7153
Mailing Address - Country:US
Mailing Address - Phone:828-208-2717
Mailing Address - Fax:
Practice Address - Street 1:27 SCHENCK PKWY
Practice Address - Street 2:SUITE 140
Practice Address - City:ASHEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28803-5516
Practice Address - Country:US
Practice Address - Phone:828-684-3497
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-09-19
Last Update Date:2016-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2386152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist