Organization
LAKES VISION, PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
CRAIG ALLEN BRATVOLD O.D. (OPTOMETRIST)
(218) 849-4295
Entity
Organization
Contact information
Practice address
1583 HIGHWAY 10 W, DETROIT LAKES, MN 56501-2232
(218) 847-7245
(218) 847-8453
Mailing address
24226 RIDGEVIEW CIR, DETROIT LAKES, MN 56501-7151
(218) 849-4295
(218) 847-8453
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
2434
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
410003242
MEDICARE PTAN
MN
Enumeration date
02/08/2010
Last updated
02/08/2010
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