Provider Demographics
NPI:1174610331
Name:D GREGORY LUCE OD PC
Entity type:Organization
Organization Name:D GREGORY LUCE OD PC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:GREGORY
Authorized Official - Last Name:LUCE
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:503-579-2020
Mailing Address - Street 1:14667 SW TEAL BLVD
Mailing Address - Street 2:
Mailing Address - City:BEAVERTON
Mailing Address - State:OR
Mailing Address - Zip Code:97007-6194
Mailing Address - Country:US
Mailing Address - Phone:503-579-2020
Mailing Address - Fax:503-579-0404
Practice Address - Street 1:14667 SW TEAL BLVD
Practice Address - Street 2:
Practice Address - City:BEAVERTON
Practice Address - State:OR
Practice Address - Zip Code:97007-6194
Practice Address - Country:US
Practice Address - Phone:503-579-2020
Practice Address - Fax:503-579-0404
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-09
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered152W00000XEye and Vision Services ProvidersOptometristGroup - Multi-Specialty
Not Answered152WC0802XEye and Vision Services ProvidersOptometristCorneal and Contact ManagementGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR0000WCNHGMedicare ID - Type Unspecified