Provider Demographics
NPI:1366986622
Name:LRL OPTICAL SYSTEMS, LLC
Entity type:Organization
Organization Name:LRL OPTICAL SYSTEMS, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LINA
Authorized Official - Middle Name:
Authorized Official - Last Name:LUKSCH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:480-963-3221
Mailing Address - Street 1:2160 W CHANDLER BLVD
Mailing Address - Street 2:SUITE 19
Mailing Address - City:CHANDLER
Mailing Address - State:AZ
Mailing Address - Zip Code:85224-6163
Mailing Address - Country:US
Mailing Address - Phone:480-963-3221
Mailing Address - Fax:480-812-8424
Practice Address - Street 1:2160 W CHANDLER BLVD
Practice Address - Street 2:SUITE 19
Practice Address - City:CHANDLER
Practice Address - State:AZ
Practice Address - Zip Code:85224-6163
Practice Address - Country:US
Practice Address - Phone:480-963-3221
Practice Address - Fax:480-812-8424
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-12-06
Last Update Date:2016-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ2631I156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOpticianGroup - Single Specialty