Organization
CARLSON TILLISCH EYE CLINIC, LTD
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. GEORGE JOHN LACH OD (OWNER)
(507) 345-5087
Entity
Organization
Contact information
Practice address
120 N BROAD ST, MANKATO, MN 56001-3518
(507) 345-5087
(507) 345-1151
Mailing address
120 N BROAD ST, MANKATO, MN 56001-3518
(507) 345-5087
(507) 345-1151
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
41663TI
BLUE CROSS & BLUE SHIELD
MN
01
—
960103100
MEDICAL ASSISTANCE
MN
Enumeration date
11/01/2006
Last updated
09/01/2022
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