LUCKY EYE CARE, PLLC , NPI 1134316086 — MALINDA LUCKY FLORES, OD in ELLENBORO (WV)

NPI 1134316086

12+ Years Experience Organization

LUCKY EYE CARE, PLLC

Other organization name: MALINDA LUCKY FLORES, OD.

09/25/2007
PROVIDER ENUMERATION DATE
05/16/2008
LAST UPDATE DATE
1134316086
NPI NUMBER

About LUCKY EYE CARE, PLLC

LUCKY EYE CARE, PLLC is a provider established in ELLENBORO, WV. The NPI number of LUCKY EYE CARE, PLLC is 1134316086 and was assigned on 09/25/2007. The practitioners primary taxonomy code is: 332H00000X with license number: WV 951-OD WV .

Mailing address

  • City: WILLIAMSTOWN
  • State: WV
  • Postal code: 261878302
  • Phone: 3043754748
  • Address: 37 ALEXANDER DR

Primary Practice Address

  • Region : ELLENBORO, WV
  • NPI : 1134316086
  • Phone : 3048693028
  • Postalcode : 26346
  • Address : 123 WEST WAGNER

Additional identifiers

  • Identifier: 1711137
  • Code / Type : 1 - other
  • Identifier state : WV
  • Identifier issuer: BCBS

Additional identifier(s) currently or formerly used as an identifier for the provider. The codes may include UPIN, NSC, OSCAR, DEA, Medicaid State or PIN identification numbers.

Additional identifiers # 2

  • Identifier: 410044882
  • Code / Type : 1 - other
  • Identifier state : WV
  • Identifier issuer : RAILROAD MEDICARE

Provider taxonomy - Eyewear Supplier

  • Taxonomy code: 332H00000X
  • License number: WV 951-OD
  • License state: WV

The taxonomy is not the primary taxonomy.

Taxonomy description: An organization that provides spectacles, contact lenses, and other vision enhancement devices prescribed by an optometrist or ophthalmologist.

Healthcare provider taxonomy #2 - Optometrist

  • Taxonomy code: 152W00000X
  • License number: 951-OD
  • License state: WV

The taxonomy is the primary taxonomy (there can be only one per NPI record).

Taxonomy description: Doctors of optometry (ODs) are the primary health care professionals for the eye. Optometrists examine, diagnose, treat, and manage diseases, injuries, and disorders of the visual system, the eye, and associated structures as well as identify related systemic conditions affecting the eye. An optometrist has completed pre-professional undergraduate education in a college or university and four years of professional education at a college of optometry, leading to the doctor of optometry (O.D.) degree. Some optometrists complete an optional residency in a specific area of practice. Optometrists are eye health care professionals state-licensed to diagnose and treat diseases and disorders of the eye and visual system.

Contacts:

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  • LUCKY EYE CARE, PLLC
  • Address : 123 WEST WAGNER
  • Region : ELLENBORO, WV
  • NPI : 1134316086
  • Phone : 3048693028
  • Postalcode : 26346

Authorized official :

{:AUTHORIZED_OFFICIAL_FIRST_NAME:} {:AUTHORIZED_OFFICIAL_MIDDLE_NAME:} {:AUTHORIZED_OFFICIAL_LAST_NAME:}
  • Phone : 3043754748
  • Title or position : OWNER
  • Credentials : O.D.

Doctors Near Your Area

Reference NPI Information. Full replica of the CMS (NPPES) NPI record

Field Name Value
Provider First Line Business Practice Location Address123 WEST WAGNER
The first line location address of the provider being identified. For providers with more than one physical location, this is the primary location. This address cannot include a Post Office box.
Provider Business Practice Location Address City NameELLENBORO
The city name in the location address of the provider being identified.
Provider Business Practice Location Address State NameWV
The State or Province name in the location address of the provider being identified.
Provider Business Practice Location Address Postal Code26346
The postal ZIP or zone code in the location address of the provider being identified. NOTE: ZIP code plus 4-digit extension, if available.
Provider Business Practice Location Address Telephone Number3048693028
The telephone number associated with the location address of the provider being identified.
NPI1134316086
10-position all-numeric identification number assigned by the NPS to uniquely identify a health care provider.
Healthcare Provider Taxonomy 1332H00000X
An organization that provides spectacles, contact lenses, and other vision enhancement devices prescribed by an optometrist or ophthalmologist.
Provider Enumeration Date09/25/2007
The date the provider was assigned a unique identifier (assigned an NPI).
Last Updated05/16/2008
The date that a record was last updated or changed.
Entity TypeOrganization
Code describing the type of health care provider that is being assigned an NPI. Codes are:
  • 1 = (Person): individual human being who furnishes health care;
  • 2 = (Non-person): entity other than an individual human being that furnishes health care (for example, hospital, SNF, hospital subunit, pharmacy, or HMO).
Is Organization SubpartN
The "Is the organization a subpart?" question must be answered. If the organization is a subpart, the Parent Organization Legal Business Name (LBN) and Parent Organization Taxpayer Identification Number (TIN) fields must be completed. The Parent Organization LBN and TIN fields can only be completed if the answer to the subpart question is Yes. Many organization health care providers who apply for NPIs are not legal entities themselves but are parts of other organization health care providers that are legal entities (the "parents"). Here are three examples of organization health care providers that may be considered subparts and may apply for NPIs if so directed by their "parents": (1) The psychiatric unit in a hospital is not a legal entity but is part of the hospital (the "parent"), which is a legal entity. The legal entity must obtain an NPI. The psychiatric unit is an example of a subpart that could have its own NPI if the hospital determines that it should. (2) A group practice that is not a sole proprietorship has a main location and could have other offices in different locations, but each office is not a separate legal entity; instead, each office is part of the corporation (the "parent") which is a legal entity. The offices are examples of subparts that could have their own NPIs if the main location determines that they should. (3) A pharmacy fills prescriptions for patients whose physicians have prescribed medications for them and may also rent or sell durable medical equipment to patients whose physicians have ordered such equipment for them. Neither the pharmacy line of business nor the DME line of business represent legal entities; instead, both lines of business are part of an organization (the "parent") that is a legal entity. Each line of business represents a different Healthcare Provider Taxonomy or area of specialization that often submits its own electronic claims to health plans. The "parent"-we don"t know who the parent is in this example-must ensure that each subpart that submits its own claims to health plans has its own NPI.
Provider Organization Name (Legal Business Name)LUCKY EYE CARE, PLLC
Provide organization name (legal business name used to file tax returns with the IRS). The Organization Name field allows the following special characters: ampersand, apostrophe, "at" sign, colon, comma, forward slash, hyphen, left and right parentheses, period, pound sign, quotation mark, and semi-colon. A field cannot contain all special characters.
Provider Other Organization NameMALINDA LUCKY FLORES, OD
Other name by which the organization provider is or has been known.
Provider Other Organization Name Type Code5
Code identifying the type of other name. Codes are: 1 = former name; 2 = professional name; 3 = doing business as (d/b/a) name; 4 = former legal business name; 5 = other.
Provider First Line Business Mailing Address37 ALEXANDER DR
The first line mailing address of the provider being identified. This data element may contain the same information as "Provider first line location address".
Provider Business Mailing Address City NameWILLIAMSTOWN
The City name in the mailing address of the provider being identified. This data element may contain the same information as "Provider location address City name".
Provider Business Mailing Address State NameWV
The State or Province name in the mailing address of the provider being identified. This data element may contain the same information as "Provider location address State name".
Provider Business Mailing Address Postal Code261878302
The postal ZIP or zone code in the mailing address of the provider being identified. NOTE: ZIP code plus 4-digit extension, if available. This data element may contain the same information as "Provider location address postal code".
Provider Business Mailing Address Telephone Number3043754748
The telephone number associated with mailing address of the provider being identified. This data element may contain the same information as "Provider location address telephone number".
Authorized Official Last NameFLORES
The last name of the person authorized to submit the NPI application or to change NPS data for a health care provider.
Authorized Official First NameMALINDA
The first name of the authorized official
Authorized Official Middle NameLUCKY
The middle name of the authorized official
Authorized Official Title or PositionOWNER
The title or position of the authorized official
Authorized Official Name Prefix TextDR.
Authorized Official Name Prefix Text
Authorized Official Credential TextO.D.
Authorized Official Credential Text
Authorized Official Telephone Number3043754748
The 10-position telephone number of the authorized official.
Healthcare Provider Taxonomy Code #1332H00000X
The Health Care Provider Taxonomy code is a unique alphanumeric code, ten characters in length. The code set is structured into three distinct "Levels" including Provider Type, Classification, and Area of Specialization.
Healthcare Provider Taxonomy 1Eyewear Supplier
An organization that provides spectacles, contact lenses, and other vision enhancement devices prescribed by an optometrist or ophthalmologist.
Provider License Number 1WV 951-OD
Certain taxonomy selections will require you to enter your license number and the state where the license was issued. Select Foreign Country in the state drop down box if the license was issued outside of United States. The License Number field allows the following special characters: ampersand, apostrophe, colon, comma, forward slash, hyphen, left and right parentheses, period, pound sign, quotation mark, and semi-colon. A field cannot contain all special characters. DO NOT report the Social Security Number (SSN), IRS Individual Taxpayer Identification Number (ITIN) in this section.
Provider License Number State Code 1WV
Healthcare Provider Primary Taxonomy Switch 1N
Primary Taxonomy:
  • X - The primary taxonomy switch is Not Answered;
  • Y - The taxonomy is the primary taxonomy (there can be only one per NPI record);
  • N - The taxonomy is not the primary taxonomy.
Healthcare Provider Taxonomy Code 2152W00000X
Healthcare Provider Taxonomy 2Optometrist
Doctors of optometry (ODs) are the primary health care professionals for the eye. Optometrists examine, diagnose, treat, and manage diseases, injuries, and disorders of the visual system, the eye, and associated structures as well as identify related systemic conditions affecting the eye. An optometrist has completed pre-professional undergraduate education in a college or university and four years of professional education at a college of optometry, leading to the doctor of optometry (O.D.) degree. Some optometrists complete an optional residency in a specific area of practice. Optometrists are eye health care professionals state-licensed to diagnose and treat diseases and disorders of the eye and visual system.
Provider License Number 2951-OD
Certain taxonomy selections will require you to enter your license number and the state where the license was issued. Select Foreign Country in the state drop down box if the license was issued outside of United States. The License Number field allows the following special characters: ampersand, apostrophe, colon, comma, forward slash, hyphen, left and right parentheses, period, pound sign, quotation mark, and semi-colon. A field cannot contain all special characters. DO NOT report the Social Security Number (SSN), IRS Individual Taxpayer Identification Number (ITIN) in this section.
Provider License Number State Code 2WV
Healthcare Provider Primary Taxonomy Switch 2Y
Primary Taxonomy:
  • X - The primary taxonomy switch is Not Answered;
  • Y - The taxonomy is the primary taxonomy (there can be only one per NPI record);
  • N - The taxonomy is not the primary taxonomy.
Other Provider Identifier 11711137
Other Provider Identifier #1
Other Provider Identifier Type 11
  • 1 - Other
  • 5 - MEDICAID
Other Provider Identifier State 1WV
Other Provider Identifier State #1
Other Provider Identifier Issuer 1BCBS
Other Provider Identifier Issuer #1
Other Provider Identifier 2410044882
Other Provider Identifier #2
Other Provider Identifier Type 21
  • 1 - Other
  • 5 - MEDICAID
Other Provider Identifier State 2WV
Other Provider Identifier State #2
Other Provider Identifier Issuer 2RAILROAD MEDICARE
Other Provider Identifier Issuer #2
X

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