Organization
LAKESHORE EYE CLINIC PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. ANDREA MOTT O.D. (OWNER/PRESIDENT)
(906) 789-1400
Entity
Organization
Contact information
Practice address
2500 7TH AVE S, 217 STE, ESCANABA, MI 49829-1176
(906) 789-1400
(906) 789-3457
Mailing address
2500 7TH AVE S, 217 STE, ESCANABA, MI 49829-1176
(906) 789-1400
(906) 789-3457
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
4901004653
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
900B10059
BCBS
MI
Enumeration date
07/01/2014
Last updated
12/10/2015
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