Organization
LAKESHORE EYE CARE PROFESSIONALS, S.C.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
LINDA L. KNAPP (OFFICE MANAGER)
(262) 241-1919
Entity
Organization
Contact information
Practice address
10320 N PORT WASHINGTON RD, MEQUON, WI 53092-5767
(262) 241-1919
(262) 241-9046
Mailing address
10320 N PORT WASHINGTON RD, MEQUON, WI 53092-5767
(262) 241-1919
(262) 241-9046
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
—
—
207W00000X
Ophthalmology Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100005006
—
WI
Enumeration date
04/18/2007
Last updated
09/20/2012
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