# LAKE COUNTRY EYE SURGERY CENTER, LLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1770458754
- **Authorized official:** ROBERT MCCARVILLE (ADMINISTRATOR)
- **Authorized official phone:** (417) 889-2040

## Contact information

- **Practice address:** N19W23993 RIDGEVIEW PKWY W, WAUKESHA, WI 53188-1030
- **Practice address phone:** (417) 889-2040
- **Mailing address:** N19W23993 RIDGEVIEW PKWY W, WAUKESHA, WI 53188-1030

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 261QA1903X | Ambulatory Surgical Clinic/Center | — | NULL | Yes |

## Other

- **Enumeration date:** 10/08/2025
- **Last updated:** 10/08/2025