Individual
DR. MICHAEL S. LACKMAN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
O.D.
Contact information
Practice address
65 DIVISION AVE, SUITE E, EUGENE, OR 97404-2485
(541) 689-1115
(541) 688-5585
Mailing address
65 DIVISION AVE, SUITE E, EUGENE, OR 97404-2485
(541) 689-1115
(541) 688-5585
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
1856ATI
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
02501-01
PACIFIC SOURCE
OR
05
—
083019
—
OR
01
—
111228
EYEMED
OR
01
—
3021
NORTHWEST BENEFIT NETWORK
OR
Enumeration date
02/10/2006
Last updated
10/10/2007
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