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Organization
LAKE TAHOE EYE CARE OPTOMETRY INC
Active
Organization
LAKE TAHOE EYE CARE OPTOMETRY INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MARK M LEHMANN OD (V PRES SECY)
(530) 541-2030
Entity
Organization
Contact information
Practice address
2074 LAKE TAHOE BLVD, SUITE 2, SO LAKE TAHOE, CA 96150-6408
(530) 541-2030
(530) 541-3947
Mailing address
2074 LAKE TAHOE BLVD, SUITE 2, SO LAKE TAHOE, CA 96150-6408
(530) 541-2030
(530) 541-3947
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
COR53
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
GSD000760
—
CA
01
—
ZZZ75623Z
MEDICARE GROUP PROVIDER #
—
Enumeration date
12/19/2006
Last updated
09/19/2008
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