Organization
LAKESIDE VISION, PRUDENVILLE, PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
KYLE BATES OD (OPTOMETRIST)
(989) 366-7525
Entity
Organization
Contact information
Practice address
888 W HOUGHTON LAKE DR, PRUDENVILLE, MI 48651-9451
(989) 366-7525
(989) 366-5405
Mailing address
PO BOX 20, PRUDENVILLE, MI 48651-0020
(989) 366-7525
(989) 366-5405
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
—
—
Other
Enumeration date
04/05/2022
Last updated
04/05/2022
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