Organization
LAKES FAMILY EYECARE, INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. GAIL E PAVLACKY (PRESIDENT)
(701) 346-3073
Entity
Organization
Contact information
Practice address
235 W MAIN ST, PERHAM, MN 56573-1448
(701) 346-3073
(701) 346-3074
Mailing address
235 W MAIN ST, PERHAM, MN 56573-1448
(701) 346-3073
(701) 346-3074
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
—
—
156FX1800X
Optician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
017304500
—
MN
01
—
340S0LA
BLUE SHIELD GROUP #
MN
Enumeration date
02/09/2007
Last updated
07/28/2009
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