Organization
LAKESIDE OPTICAL INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
BETHANY KAY ALLEN LDO (PRESIDENT)
(727) 398-7500
Entity
Organization
Contact information
Practice address
6595 SEMINOLE BLVD, SEMINOLE, FL 33772-6314
(727) 398-7500
(727) 398-4851
Mailing address
6595 SEMINOLE BLVD, SEMINOLE, FL 33772-6314
(727) 398-7500
(727) 398-4851
Taxonomy
Speciality
Code
Description
License number
State
156FX1800X
Optician
Primary
OE 0000300
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
C08421572
PALMETTO EDI SUBMITTER #
—
01
—
D7661
BC/BS FL SUPPLIER NUMBER
FL
Enumeration date
06/02/2006
Last updated
02/01/2012
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