Organization
LAKE STREET OPTICAL
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. DAVID D DEWAARD O.D. (OWNER)
(630) 892-0244
Entity
Organization
Contact information
Practice address
1036 N LAKE ST, AURORA, IL 60506-2467
(630) 892-0244
(630) 947-0419
Mailing address
1036 N LAKE ST, AURORA, IL 60506-2467
(630) 892-0244
(630) 947-0419
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
04607174
IL
Other
Enumeration date
06/10/2010
Last updated
06/10/2010
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