Provider Demographics
NPI:1053385062
Name:PLATT, LUCAS OLIVER JR (DO)
Entity type:Individual
Prefix:DR
First Name:LUCAS
Middle Name:OLIVER
Last Name:PLATT
Suffix:JR
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:CHIP
Other - Middle Name:
Other - Last Name:PLATT
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:1655 BERNARDIN AVE.
Mailing Address - Street 2:STE 100
Mailing Address - City:COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29204-2039
Mailing Address - Country:US
Mailing Address - Phone:803-256-0641
Mailing Address - Fax:803-779-3649
Practice Address - Street 1:1655 BERNARDIN AVE.
Practice Address - Street 2:STE 100
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29204-2039
Practice Address - Country:US
Practice Address - Phone:803-256-0641
Practice Address - Fax:803-779-3649
Is Sole Proprietor?:No
Enumeration Date:2006-02-15
Last Update Date:2015-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARE-1470207W00000X
SCMDO.1619DO207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR141684003Medicaid
MI1805110040Medicaid
MIH26286Medicare UPIN
MI1805110040Medicaid
AR5L627Medicare ID - Type Unspecified
MIOA16290011Medicare PIN