Provider Demographics
NPI:1285608414
Name:LUKES, GARY BRYAN (OD)
Entity type:Individual
Prefix:DR
First Name:GARY
Middle Name:BRYAN
Last Name:LUKES
Suffix:
Gender:M
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:PO BOX 10
Mailing Address - Street 2:344 E EAU GALLE RD
Mailing Address - City:SPRING VALLEY
Mailing Address - State:WI
Mailing Address - Zip Code:54767-9001
Mailing Address - Country:US
Mailing Address - Phone:715-778-5876
Mailing Address - Fax:715-778-5874
Practice Address - Street 1:344 E EAU GALLE RD
Practice Address - Street 2:
Practice Address - City:SPRING VALLEY
Practice Address - State:WI
Practice Address - Zip Code:54767-9001
Practice Address - Country:US
Practice Address - Phone:715-778-5876
Practice Address - Fax:715-778-5874
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-14
Last Update Date:2013-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI1954152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI1012515OtherPREFERRED ONE
WI92026LUOtherBC/BC/WI
WI92028VAOtherBC/BS/WI
WI18235OtherHEALTH PARTNERS
WV2210848OtherMEDICA
WI391448892OtherNVA
WIW2913 300OtherSELECT CARE
WI385-22-700Medicaid
WI92026LUOtherBC/BC/WI
WI385-22-700Medicaid
WIW2913 300OtherSELECT CARE
WIT62646Medicare UPIN