Provider Demographics
NPI:1245472117
Name:LUCAS, GARY (LAC)
Entity type:Individual
Prefix:MR
First Name:GARY
Middle Name:
Last Name:LUCAS
Suffix:
Gender:M
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 GROVE ST
Mailing Address - Street 2:SUITE 117
Mailing Address - City:PITTSFORD
Mailing Address - State:NY
Mailing Address - Zip Code:14534-1300
Mailing Address - Country:US
Mailing Address - Phone:585-721-6879
Mailing Address - Fax:
Practice Address - Street 1:1 GROVE ST
Practice Address - Street 2:SUITE 117
Practice Address - City:PITTSFORD
Practice Address - State:NY
Practice Address - Zip Code:14534-1300
Practice Address - Country:US
Practice Address - Phone:585-721-6879
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-03-24
Last Update Date:2009-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY25 003934171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist