Active NPI
John Lackey, Inc
- Eyewear Supplier
- Summersville, WV
National Provider Identifier
1609904663
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Eyewear Supplier
- License
- 736
- Legal business name
- JOHN LACKEY, INC
- Practice address
- 702 Professional Park Dr
Suite102
Summersville, WV 26651-2018 - Phone
- (304) 872-6433
- Fax
- (304) 872-6562
- NPI assigned
- Mar 1, 2007
- Organization subpart
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Authorized official
- Name
- Dr. John Lackey, D.O.
- Title
- Owner
- Phone
- (304) 872-6433
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Eyewear Supplier | 332H00000X | 736 | WV | Primary |
Addresses
Primary practice location
702 Professional Park Dr
Suite102
Summersville, WV 26651-2018
Mailing address
702 Professional Park Dr
Suite 102
Summersville, WV 26651-2018
Phone (304) 872-6433
Other identifiers 4
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1205951605 | Other | WV | MEDICARE GROUP PAYER NPI (MEDICAL PRACTICE) |
| 1609904663 | Other | WV | DME SUPPLIER NPI |
| 00094926001 | Other | WV | MEDICAID OPTICAL SUPPLIER NUMBER |
| 0257640001 | Other | WV | MEDICARE DME PTAN (SUPPLIER PTAN) |
Other names 1
- Dr. John Lackey, Inc.
National Provider Directory
National Provider DirectoryLocations
702 Professional Park Dr
Summersville, WV 26651
Phone (304) 872-8424
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1172707200000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1320278400000",
"number": "1609904663",
"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": "SUITE102",
"city": "SUMMERSVILLE",
"state": "WV",
"postal_code": "266512018",
"telephone_number": "304-872-6433",
"fax_number": "304-872-6562"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "JOHN LACKEY, INC",
"organizational_subpart": "NO",
"enumeration_date": "2007-03-01",
"last_updated": "2011-11-03",
"status": "A",
"authorized_official_last_name": "LACKEY",
"authorized_official_first_name": "JOHN",
"authorized_official_title_or_position": "OWNER",
"authorized_official_telephone_number": "304-872-6433",
"authorized_official_name_prefix": "Dr.",
"authorized_official_credential": "D.O."
},
"taxonomies": [
{
"code": "332H00000X",
"taxonomy_group": "",
"desc": "Eyewear Supplier",
"state": "WV",
"license": "736",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "MEDICARE GROUP PAYER NPI (MEDICAL PRACTICE)",
"identifier": "1205951605",
"state": "WV"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "DME SUPPLIER NPI",
"identifier": "1609904663",
"state": "WV"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "MEDICAID OPTICAL SUPPLIER NUMBER",
"identifier": "00094926001",
"state": "WV"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "MEDICARE DME PTAN (SUPPLIER PTAN)",
"identifier": "0257640001",
"state": "WV"
}
],
"endpoints": [],
"other_names": [
{
"organization_name": "Dr. John Lackey, Inc.",
"code": "5",
"type": "Other Name"
}
]
}Other providers in Summersville, WV
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 3, 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.