Organization
LAKE COUNTRY EYE CARE, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. AMBER A DENTZ O.D. (OPTOMETRIST/OWNER)
(262) 367-6610
Entity
Organization
Contact information
Practice address
520 HARTBROOK DR STE F, HARTLAND, WI 53029-1402
(262) 367-6610
(262) 367-0964
Mailing address
520 HARTBROOK DR STE F, HARTLAND, WI 53029-1402
(262) 367-6610
(262) 367-0964
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
2878-035
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
11533287
CAQH
WI
05
—
152WOOOOX
—
WI
Enumeration date
11/05/2014
Last updated
06/30/2015
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