Individual
REBECCA A. LAKE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
612 ROSEBUD PLZ, CLARKSBURG, WV 26301-9386
(304) 622-1251
(304) 622-2352
Mailing address
612 ROSEBUD PLZ, CLARKSBURG, WV 26301-9386
(304) 622-1251
(304) 622-2352
Taxonomy
Speciality
Code
Description
License number
State
156FX1800X
Optician
Primary
024447
WV
Other
Enumeration date
10/06/2006
Last updated
07/08/2007
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