Provider Demographics
NPI:1861425662
Name:WERKHOVEN, LUKE (OD)
Entity type:Individual
Prefix:DR
First Name:LUKE
Middle Name:
Last Name:WERKHOVEN
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5300 HOLLISTER AVE
Mailing Address - Street 2:
Mailing Address - City:SANTA BARBARA
Mailing Address - State:CA
Mailing Address - Zip Code:93111-2306
Mailing Address - Country:US
Mailing Address - Phone:805-692-6977
Mailing Address - Fax:
Practice Address - Street 1:5300 HOLLISTER AVE
Practice Address - Street 2:
Practice Address - City:SANTA BARBARA
Practice Address - State:CA
Practice Address - Zip Code:93111-2306
Practice Address - Country:US
Practice Address - Phone:805-692-6977
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-08
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA11977T152WL0500X, 152WC0802X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152WC0802XEye and Vision Services ProvidersOptometristCorneal and Contact Management
No152WL0500XEye and Vision Services ProvidersOptometristLow Vision Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA11977TOtherSTATE OPT LISC. #
59-3792228OtherCURRENT TAX ID #
WY622OtherMEDICARE
77-0049461OtherOLD TAX ID#
77-0049461OtherOLD TAX ID#
MW0861078OtherDEA #
CA6057190001Medicare NSC
WY622OtherMEDICARE