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Organization
LAKESHORE VISION CENTERS LTD
Active
Organization
LAKESHORE VISION CENTERS LTD
Active
Organization subpart
No
Provider details
NPI number
Authorized official
SUSAN A GORZ OD (CO OWNER VICE PRESIDENT)
(920) 487-2020
Entity
Organization
Contact information
Practice address
1217 ELLIS ST, KEWAUNEE, WI 54216
(920) 388-2020
(920) 388-3594
Mailing address
1217 ELLIS ST, KEWAUNEE, WI 54216
(920) 388-2020
(920) 388-3594
Taxonomy
Speciality
Code
Description
License number
State
261Q00000X
Clinic/Center
Primary
—
NULL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000047383
MEDICARE PTAN
WI
Enumeration date
01/12/2007
Last updated
04/22/2009
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