Provider Demographics
NPI:1184784308
Name:JONCAS, LUC R (OD)
Entity type:Individual
Prefix:
First Name:LUC
Middle Name:R
Last Name:JONCAS
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:3918 HAZY LN
Mailing Address - Street 2:
Mailing Address - City:OKEMOS
Mailing Address - State:MI
Mailing Address - Zip Code:48864-5226
Mailing Address - Country:US
Mailing Address - Phone:517-321-5545
Mailing Address - Fax:517-321-8344
Practice Address - Street 1:5346 W SAGINAW HWY
Practice Address - Street 2:LANSING MALL
Practice Address - City:LANSING
Practice Address - State:MI
Practice Address - Zip Code:48917-2455
Practice Address - Country:US
Practice Address - Phone:517-321-5545
Practice Address - Fax:517-321-8344
Is Sole Proprietor?:No
Enumeration Date:2006-12-11
Last Update Date:2010-03-26
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MI4901002969152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIN26930095Medicare PIN
MIU38279Medicare UPIN