Provider Demographics
NPI:1841255270
Name:LUKKARINEN, TARA D (OD)
Entity type:Individual
Prefix:DR
First Name:TARA
Middle Name:D
Last Name:LUKKARINEN
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:315 PARHAM ST
Mailing Address - Street 2:SUITE B
Mailing Address - City:MUSCATINE
Mailing Address - State:IA
Mailing Address - Zip Code:52761-2604
Mailing Address - Country:US
Mailing Address - Phone:563-263-7577
Mailing Address - Fax:563-263-7814
Practice Address - Street 1:315 PARHAM ST
Practice Address - Street 2:SUITE B
Practice Address - City:MUSCATINE
Practice Address - State:IA
Practice Address - Zip Code:52761-2604
Practice Address - Country:US
Practice Address - Phone:563-263-7577
Practice Address - Fax:563-263-7814
Is Sole Proprietor?:No
Enumeration Date:2006-04-19
Last Update Date:2014-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA02113152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0452417Medicaid
IA18994OtherBLUE CROSS BLUE SHIELD
IA18994OtherBLUE CROSS BLUE SHIELD
IA0517610001Medicare NSC
IAV00359Medicare UPIN