Organization
LG VISION SERVICES LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
LANCE GUTFLEISCH OD (OWNER)
(763) 784-4102
Entity
Organization
Contact information
Practice address
8150 UNIVERSITY AVE NE, FRIDLEY, MN 55432-1864
(763) 784-4102
Mailing address
PO BOX 1170, MAPLE GROVE, MN 55311-6170
(763) 746-2094
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
2965
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1861550741
INDIVIDUAL-TYPE I NPI
MN
Enumeration date
05/04/2017
Last updated
05/04/2017
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