NPI 1003434622

Lost Lake Optical Company

Organisation Clinic/Center Mound, MN

Practice location

Address: 5240 Shady Island Cir, Mound, MN 55364-9222
Phone: (612) 670-8887
Fax: (952) 474-1933

Authorised official

Name: Jay B. Petersen
Title: Owner
Phone: (612) 670-8887

Registered specialties

Clinic/Center Primary

Ambulatory Health Care Facilities Taxonomy 261Q00000X

Other Clinic/Center providers in Minnesota →

Registry record

NPI: 1003434622
Entity type: Organization
NPI issued: 9 Jul 2020
Record last updated: 4 Sep 2020

Reproduced from NPPES, the federal provider registry. The date above is when the provider last updated their own entry, not when we fetched it - a record can be years old and still current in the registry.