Provider Demographics
NPI:1528075843
Name:LUX, RICHARD V (CERTIFIED ORTHOTIST)
Entity type:Individual
Prefix:
First Name:RICHARD
Middle Name:V
Last Name:LUX
Suffix:
Gender:M
Credentials:CERTIFIED ORTHOTIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1307 W 20TH ST
Mailing Address - Street 2:
Mailing Address - City:JOPLIN
Mailing Address - State:MO
Mailing Address - Zip Code:64804-1700
Mailing Address - Country:US
Mailing Address - Phone:417-624-2332
Mailing Address - Fax:417-624-0599
Practice Address - Street 1:1307 W 20TH ST
Practice Address - Street 2:
Practice Address - City:JOPLIN
Practice Address - State:MO
Practice Address - Zip Code:64804-1700
Practice Address - Country:US
Practice Address - Phone:417-624-2332
Practice Address - Fax:417-624-0599
Is Sole Proprietor?:No
Enumeration Date:2006-08-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes222Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOrthotist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO106787OtherBLUE CROSS
MO1138880001Medicare ID - Type Unspecified