Organization
LAKE OPTOMETRIC VISION PA
Active
Other names
lindstrom optical
Organization subpart
No
Provider details
NPI number
Authorized official
DR. VERNON BRUCE LOVDOKKEN OD (OWNER)
(651) 257-2419
Entity
Organization
Contact information
Practice address
12700 LAKE BLVD, LINDSTROM, MN 55045
(651) 257-2419
(651) 257-2419
Mailing address
12700 LAKE BLVD, BOX 552, LINDSTROM, MN 55045
(651) 257-2419
(651) 257-2419
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
2142
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1861534315
HEALTHPARTNERS
MN
01
—
2214338
MEDICA
MN
01
—
45964
PREFERREDONE
MN
01
—
59389LO
BLUE CROSS BLUE SHIELD
MN
05
—
628823500
—
MN
Enumeration date
05/19/2008
Last updated
05/19/2008
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