Provider Demographics
NPI:1336974278
Name:LUMINOUZ EXPERIENCE
Entity type:Organization
Organization Name:LUMINOUZ EXPERIENCE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:LYNITA
Authorized Official - Middle Name:
Authorized Official - Last Name:POPE-BARNHILL
Authorized Official - Suffix:
Authorized Official - Credentials:CERTIFIED
Authorized Official - Phone:757-698-8633
Mailing Address - Street 1:166 NAUTICO WAY
Mailing Address - Street 2:
Mailing Address - City:PORTSMOUTH
Mailing Address - State:VA
Mailing Address - Zip Code:23703-5469
Mailing Address - Country:US
Mailing Address - Phone:757-698-8633
Mailing Address - Fax:
Practice Address - Street 1:166 NAUTICO WAY
Practice Address - Street 2:
Practice Address - City:PORTSMOUTH
Practice Address - State:VA
Practice Address - Zip Code:23703-5469
Practice Address - Country:US
Practice Address - Phone:757-698-8633
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-09-02
Last Update Date:2024-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier