Individual
MICHAEL DAVID LACK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
O.D.
Contact information
Practice address
450 MARGARET ST, PLATTSBURGH, NY 12901-1755
(518) 566-2020
(518) 561-5390
Mailing address
450 MARGARET ST, PLATTSBURGH, NY 12901-1755
(518) 566-2020
(518) 561-5390
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
TUV003563-1
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00568070
—
NY
Enumeration date
05/11/2006
Last updated
06/30/2020
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