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Contact Information

LAKE OPTOMETRIC VISION PA
12700 LAKE BLVD
LINDSTROM, MN55045
 Phone: 651-257-2419
 Fax: 651-257-2419
 Website:
 

Specialty

Taxonomy Code Specialty Code Provider Type

Optometrist

152W00000X 41 Optometry
Indicates primary specialty

NPI Profile & details for LAKE OPTOMETRIC VISION PA · (Female)

NPI # 1831356773
Status Active
Credentials
Entity Individual
Enumeration date 05/19/2008
Last updated 05/19/2008 - About 18 years ago
Sole proprietor 1 Not specified
Identifiers
  • MN License # 2142
  • MN Medicaid 628823500
  • MN Other 59389LO BLUE CROSS BLUE SHIELD
  • MN Other 1861534315 HEALTHPARTNERS
  • MN Other 2214338 MEDICA
  • MN Other 45964 PREFERREDONE
Hospital affiliation(s) Not Available
1 A sole proprietor/sole proprietorship is an individual, and as such, is eligible for a single NPI number. The sole proprietor must apply for the NPI number using his or her own Social Security Number (SSN), not an Employer Identification Number (EIN) even if he/she has an EIN.

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