Organization
LAKESHORE VISION CENTERS, LTD
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. SUSAN A. GORZ O.D. (CO-OWNER, VICE-PRESIDENT)
(920) 487-2020
Entity
Organization
Contact information
Practice address
1021 JEFFERSON ST., ALGOMA, WI 54201
(920) 487-2020
(920) 487-5022
Mailing address
1021 JEFFERSON ST., ALGOMA, WI 54201
(920) 487-2020
(920) 487-5022
Taxonomy
Speciality
Code
Description
License number
State
261Q00000X
Clinic/Center
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000047383
MEDICARE PTAN
WI
Enumeration date
01/12/2007
Last updated
04/22/2009
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