Provider Demographics
NPI:1386121911
Name:LUX-O'CALLAGHAN, CASSONDRA JO (OD)
Entity type:Individual
Prefix:
First Name:CASSONDRA
Middle Name:JO
Last Name:LUX-O'CALLAGHAN
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 1:411 W 39TH ST
Mailing Address - Street 2:
Mailing Address - City:KEARNEY
Mailing Address - State:NE
Mailing Address - Zip Code:68845-2805
Mailing Address - Country:US
Mailing Address - Phone:308-865-2760
Mailing Address - Fax:
Practice Address - Street 1:711 N CUSTER AVE STE G
Practice Address - Street 2:
Practice Address - City:GRAND ISLAND
Practice Address - State:NE
Practice Address - Zip Code:68803-4311
Practice Address - Country:US
Practice Address - Phone:308-865-2760
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-07-26
Last Update Date:2021-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK2991152W00000X
NE1531152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist