Provider Demographics
NPI:1194800011
Name:LUTSKY, JEFFREY (OPTICIAN)
Entity type:Individual
Prefix:
First Name:JEFFREY
Middle Name:
Last Name:LUTSKY
Suffix:
Gender:M
Credentials:OPTICIAN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:31 STONEGATE DR
Mailing Address - Street 2:
Mailing Address - City:WATCHUNG
Mailing Address - State:NJ
Mailing Address - Zip Code:07069-5471
Mailing Address - Country:US
Mailing Address - Phone:908-229-4266
Mailing Address - Fax:
Practice Address - Street 1:1330 PARKWAY AVE
Practice Address - Street 2:EYESTYLES
Practice Address - City:TRENTON
Practice Address - State:NJ
Practice Address - Zip Code:08628-3006
Practice Address - Country:US
Practice Address - Phone:609-883-1800
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJTD1927156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician