Basic Information
| Provider Information | |||||||||
| NPI: | 1942399456 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | LUEHMANN | ||||||||
| FirstName: | VICKI | ||||||||
| MiddleName: | SUE | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | O.D. | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | BOROWICZ | ||||||||
| OtherFirstName: | VICKI | ||||||||
| OtherMiddleName: | SUE | ||||||||
| OtherNamePrefix: | DR. | ||||||||
| OtherNameSuffix: | |||||||||
| OtherCredential: | O.D. | ||||||||
| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | 223 1ST ST E | ||||||||
| Address2: | SUITE 101 | ||||||||
| City: | JORDAN | ||||||||
| State: | MN | ||||||||
| PostalCode: | 553521561 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9524922350 | ||||||||
| FaxNumber: | 9524926162 | ||||||||
| Practice Location | |||||||||
| Address1: | 223 1ST ST E | ||||||||
| Address2: | SUITE 101 | ||||||||
| City: | JORDAN | ||||||||
| State: | MN | ||||||||
| PostalCode: | 553521561 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9524922350 | ||||||||
| FaxNumber: | 9524926162 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/12/2006 | ||||||||
| LastUpdateDate: | 08/22/2012 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| AuthorizedOfficialTitleorPosition: | |||||||||
| AuthorizedOfficialTelephone: | |||||||||
| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 152W00000X | 2848000 | MN | Y | Eye and Vision Services Providers | Optometrist | 152WC0802X | 2848000 | MN | N | Eye and Vision Services Providers | Optometrist | Corneal and Contact Management | 152WP0200X | 2848000 | MN | N | Eye and Vision Services Providers | Optometrist | Pediatrics | 152WS0006X | 2848000 | MN | N | Eye and Vision Services Providers | Optometrist | Sports Vision | 152WX0102X | 2848000 | MN | N | Eye and Vision Services Providers | Optometrist | Occupational Vision |
ID Information
| ID | Type | State | Issuer | Description | 2201857 | 01 | MN | MEDICA | OTHER | 51M08BO | 01 | MN | BLUE CROSS BLUE SHIELD | OTHER | 1725622 | 01 | MN | AMERICAS PPO | OTHER | MB1108794 | 01 | DEA | OTHER | HP29343 | 01 | MN | HEALTH PARTNERS | OTHER | XX1901032963 | 01 | MN | PREFERRED ONE | OTHER | 132580900 | 05 | MN | MEDICAID | 142943 | 01 | MN | UCARE | OTHER |