Basic Information
| Provider Information | |||||||||
| NPI: | 1639621444 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | LUTCHMAN | ||||||||
| FirstName: | JENELLA | ||||||||
| MiddleName: | DHEA | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | O.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4927 MAIN ST | ||||||||
| Address2: | SUITE 300 | ||||||||
| City: | AMHERST | ||||||||
| State: | NY | ||||||||
| PostalCode: | 142264081 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7168391780 | ||||||||
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| Practice Location | |||||||||
| Address1: | 4927 MAIN ST | ||||||||
| Address2: | SUITE 300 | ||||||||
| City: | AMHERST | ||||||||
| State: | NY | ||||||||
| PostalCode: | 142264081 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7168391780 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 10/27/2016 | ||||||||
| LastUpdateDate: | 10/27/2016 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 152W00000X | 008515 | NY | Y | Eye and Vision Services Providers | Optometrist |
No ID Information.