Provider Demographics
NPI:1366413023
Name:LUCHS, JODI IAN (MD)
Entity type:Individual
Prefix:
First Name:JODI
Middle Name:IAN
Last Name:LUCHS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:1050 SE MONTEREY RD STE 104
Mailing Address - Street 2:
Mailing Address - City:STUART
Mailing Address - State:FL
Mailing Address - Zip Code:34994-4512
Mailing Address - Country:US
Mailing Address - Phone:772-283-2020
Mailing Address - Fax:772-219-7924
Practice Address - Street 1:1515 N FLAGLER DR STE 500
Practice Address - Street 2:
Practice Address - City:WEST PALM BEACH
Practice Address - State:FL
Practice Address - Zip Code:33401-3430
Practice Address - Country:US
Practice Address - Phone:561-659-9700
Practice Address - Fax:561-659-7153
Is Sole Proprietor?:No
Enumeration Date:2006-01-31
Last Update Date:2019-01-09
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY190065207W00000X
FLME137741207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY74T2034001Medicare PIN
NY74T201Medicare ID - Type Unspecified
NYG20892Medicare UPIN