JOHN LACKEY INC NPI 1609904663

NPI Information

NPI: 1609904663
Provider Name: JOHN LACKEY, INC
Classification: Eyewear Supplier - 332H00000X
Entity Type: Organization
Other Name: DR. JOHN LACKEY, INC.
Address: 702 PROFESSIONAL PARK DR
SUITE102
SUMMERSVILLE, WV
ZIP 26651
Phone: (304) 872-6433

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NPI Details

JOHN LACKEY, INC is an eyewear supplier in Summersville, WV. The provider is an organization that provides spectacles, contact lenses, and other vision enhancement devices prescribed by an optometrist or ophthalmologist. JOHN LACKEY, INC NPI is 1609904663. The provider is registered as an organization entity type.
The provider Other Name Is Dr. John Lackey, Inc..

The provider's business location address is:

702 PROFESSIONAL PARK DR
SUITE102
SUMMERSVILLE, WV
ZIP 26651-018
Phone: (304) 872-6433
Fax: (304) 872-6562

The provider's authorized official is John Lackey .
The authorized official title is Owner and has the following contact phone number (304) 872-6433.

The enumeration date for this NPI number is 3/1/2007 and was last updated on 11/3/2011.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.	Taxonomy Code	Taxonomy Clasification	Taxonomy Specialization	License Number	License State	Primary
1	332H00000X	Eyewear Supplier		736	WEST VIRGINIA	Yes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No.	Other Provider Identifier	Other Provider Identifier Type	Other Provider Identifier State	Other Provider Identifier Issuer
1	1205951605	OTHER	WEST VIRGINIA	MEDICARE GROUP PAYER NPI (MEDICAL PRACTICE)
2	1609904663	OTHER	WEST VIRGINIA	DME SUPPLIER NPI
3	00094926001	OTHER	WEST VIRGINIA	MEDICAID OPTICAL SUPPLIER NUMBER
4	0257640001	OTHER	WEST VIRGINIA	MEDICARE DME PTAN (SUPPLIER PTAN)

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 11/21/2025

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