Individual
VAN LUCAS II
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
O.D.
Contact information
Practice address
301 NORTHLAKE AVE STE 101, RIDGELAND, MS 39157-1720
(601) 707-5255
(601) 707-5783
Mailing address
301 NORTHLAKE AVE STE 101, RIDGELAND, MS 39157-1720
(601) 707-5255
(601) 707-5783
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
583
MS
Other
Enumeration date
02/09/2012
Last updated
06/04/2024
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