Active NPI
Phillip Mark Lueckenhoff, O.D.
- Optometrist
- Overland, MO
National Provider Identifier
1063862969
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Optometrist
- License
- 2016020853
- Practice address
- 2533 Woodson Rd
Overland, MO 63114-5436 - Phone
- (314) 423-3874
- NPI assigned
- Jun 21, 2016
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Optometrist | 152W00000X | 2016020853 | MO | Primary |
Addresses
Primary practice location
2533 Woodson Rd
Overland, MO 63114-5436
Mailing address
2533 Woodson Rd
Overland, MO 63114-5436
Phone (314) 423-3874
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in MO
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: No
- Hospice: Yes
Enrollment records 1
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Overland Optical, Inc. | Current | Accepting new patients | |
| Overland Optical, Inc | Past | Accepting new patients |
Locations
2533 Woodson Rd
Saint Louis, MO 63114
Phone (314) 423-3874
Interoperability endpoints
- phillip.lueckenhoff.1@14940.direct.athenahealth.com
Organizations & group practices 2
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
-
dba Overland Optical Family Eye Care
- Optician
- Saint Charles, MO
- NPI 1396833174
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1466467200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1466467200000",
"number": "1063862969",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2533 WOODSON RD",
"city": "OVERLAND",
"state": "MO",
"postal_code": "631145436",
"telephone_number": "314-423-3874"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2533 WOODSON RD",
"city": "OVERLAND",
"state": "MO",
"postal_code": "631145436",
"telephone_number": "314-423-3874"
}
],
"practiceLocations": [],
"basic": {
"last_name": "LUECKENHOFF",
"first_name": "PHILLIP",
"middle_name": "MARK",
"name_prefix": "Dr.",
"credential": "O.D.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2016-06-21",
"last_updated": "2016-06-21",
"status": "A"
},
"taxonomies": [
{
"code": "152W00000X",
"taxonomy_group": "",
"desc": "Optometrist",
"state": "MO",
"license": "2016020853",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Overland, MO
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- Mercy & Miracle Health Services LLC
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Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 21, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.