Organization
MICHAEL D LACK OD
Active
Other names
North Country Optical
Organization subpart
No
Provider details
NPI number
Authorized official
MICHAEL DAVID LACK O.D. (OWNER)
(518) 563-7400
Entity
Organization
Contact information
Practice address
292 CORNELIA ST BLDG 2, PLATTSBURGH, NY 12901-2303
(518) 563-7400
Mailing address
292 CORNELIA ST BLDG 2, PLATTSBURGH, NY 12901-2303
(518) 563-7400
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
TUV003563-1
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00568070
—
NY
Enumeration date
01/03/2007
Last updated
10/25/2011
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