Individual
LUC EMMANUEL KANICKY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
O.D.
Contact information
Practice address
6911 PISTOL RANGE RD, SUITE 103B, TAMPA, FL 33635-6335
(813) 925-3393
(813) 925-3394
Mailing address
6911 PISTOL RANGE RD, SUITE 103B, TAMPA, FL 33635-6335
(813) 925-3393
(813) 925-3394
Taxonomy
Speciality
Code
Description
License number
State
152WL0500X
Low Vision Rehabilitation Optometrist
Primary
OPC 003906
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
OPC 003906
STATE LICENSE
FL
Enumeration date
04/20/2006
Last updated
05/06/2010
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