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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

NPI # 1831356773
LBN Legal business name LAKE OPTOMETRIC VISION PA
Authorized official VERNON LOVDOKKEN - (OWNER)
Entity Organization
Organization subpart 1 No
Enumeration date 05/19/2008
Last updated 05/19/2008 - About 18 years ago
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
1 Some organization health care providers are made up of components that furnish different types of health care or have separate physical locations where health care is furnished. These components and physical locations are not themselves legal entities, but are part of the organization health care provider (which is a legal entity). A covered organization provider may decide that its subparts (if it has any) should have their own NPI numbers. If a subpart conducts any HIPAA standard transactions on its own (e.g., separately from its parent), it must obtain its own NPI number.

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