NPI 1790789550

Lakeside Vision INC

Organisation Optometrist Prudenville, MI

Practice location

Address: 888 W Houghton Lake Dr, Prudenville, MI 48651-9451
Phone: (989) 366-7525
Fax: (989) 366-5405
Mailing address: 888 W Houghton Lake Dr P O Box 20, Prudenville, MI 48651-9451

Authorised official

Name: Jennifer Boggs
Title: Office Manager
Phone: (989) 366-7525

Registered specialties

Optometrist Primary

Eye and Vision Services Providers Taxonomy 152W00000X Licence MI2953 (MI)

Other Optometrist providers in Michigan →

Registry record

NPI: 1790789550
Entity type: Organization
NPI issued: 9 Jun 2005
Record last updated: 16 Jul 2008

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.