Dr John Lackey Inc

Primary specialty

Ophthalmology PhysicianTaxonomy code 207W00000X

License

736 WV Issued in WV

Legal business name

DR JOHN LACKEY INC

Practice address

702 Professional Park Dr
Suite 102
Summersville, WV 26651-2018

Phone

(304) 872-6433

Fax

(304) 872-6562

NPI assigned

Mar 21, 2007

Last updated

Feb 21, 2011By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

John K Lackey, D.O.

Title

Owner Physician

Phone

(304) 872-6433

Specialties & licenses 1

Addresses

Other identifiers 5

Other names 1

• John K. Lackey, D.O. Other name

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1174435200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1298246400000",
    "number": "1205951605",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "702 PROFESSIONAL PARK DR",
            "address_2": "SUITE 102",
            "city": "SUMMERSVILLE",
            "state": "WV",
            "postal_code": "266512018",
            "telephone_number": "304-872-6433",
            "fax_number": "304-872-6562"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "702 PROFESSIONAL PARK DR",
            "address_2": "SUITE 102",
            "city": "SUMMERSVILLE",
            "state": "WV",
            "postal_code": "266512018",
            "telephone_number": "304-872-6433",
            "fax_number": "304-872-6562"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DR JOHN LACKEY INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-03-21",
        "last_updated": "2011-02-21",
        "status": "A",
        "authorized_official_last_name": "LACKEY",
        "authorized_official_first_name": "JOHN",
        "authorized_official_middle_name": "K",
        "authorized_official_title_or_position": "OWNER PHYSICIAN",
        "authorized_official_telephone_number": "304-872-6433",
        "authorized_official_credential": "D.O."
    },
    "taxonomies": [
        {
            "code": "207W00000X",
            "taxonomy_group": "",
            "desc": "Ophthalmology",
            "state": "WV",
            "license": "736 WV",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICAID - SUPPLIER",
            "identifier": "0094926001",
            "state": "WV"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICAID GROUP",
            "identifier": "0094926002",
            "state": "WI"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE RAILROAD GROUP",
            "identifier": "DG9055",
            "state": "WV"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NPI - GROUP",
            "identifier": "1205951605",
            "state": "WV"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "UMWA FUNDS",
            "identifier": "1329809",
            "state": "WV"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "John K. Lackey, D.O.",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

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• Ophthalmology Physician in Summersville, WV
• Providers in Summersville, WV by specialty
• Ophthalmology Physician in West Virginia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 21, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.