Lakeside Vision, Prudenville, PC

Primary specialty

OptometristTaxonomy code 152W00000X

Legal business name

LAKESIDE VISION, PRUDENVILLE, PC

Practice address

888 W Houghton Lake Dr
Prudenville, MI 48651-9451

Phone

(989) 366-7525

Fax

(989) 366-5405

NPI assigned

Apr 5, 2022

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Kyle Bates, ODNPI 1932767191

Title

Optometrist

Phone

(989) 366-7525

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in MI

Enrollment records 1

Practitioners 5

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Kyle Scott Bates, OD

  • Optometrist
  • Prudenville, MI
  • NPI 1932767191
  Medicare reassignment NPD Authorized official
• Louis E Boggs, O.D.

  • Optometrist
  • Prudenville, MI
  • NPI 1134123987
  Medicare reassignment NPD
• Ryan Chrencik, OD

  • Optometrist
  • Louisville, KY
  • NPI 1487427316

  MI

  Medicare reassignment NPD
• David S Cook, O.D.

  • Optometrist
  • Cadillac, MI
  • NPI 1780753749
  NPD (past)
• Virginia Gilmore, O.D.

  • Optometrist
  • Bangor, ME
  • NPI 1821000258
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1649116800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1649116800000",
    "number": "1003557133",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 20",
            "city": "PRUDENVILLE",
            "state": "MI",
            "postal_code": "486510020",
            "telephone_number": "989-366-7525",
            "fax_number": "989-366-5405"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "888 W HOUGHTON LAKE DR",
            "city": "PRUDENVILLE",
            "state": "MI",
            "postal_code": "486519451",
            "telephone_number": "989-366-7525",
            "fax_number": "989-366-5405"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LAKESIDE VISION, PRUDENVILLE, PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2022-04-05",
        "last_updated": "2022-04-05",
        "certification_date": "2022-04-05",
        "status": "A",
        "authorized_official_last_name": "BATES",
        "authorized_official_first_name": "KYLE",
        "authorized_official_title_or_position": "OPTOMETRIST",
        "authorized_official_telephone_number": "989-366-7525",
        "authorized_official_credential": "OD"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Optometrist",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Kronner Pharmacy Inc
• Madison Leigh Kudla
• Emalee Katherine Lademan, RBT
• Kendra Lahaie
• Lakeside Vision Inc
• Michelle Ann Langusch, M.A.
• Courtenay Larkin
• Nichole Lynn Latowski
• Sheryl Ann Leonard
• Hannah Lewis

• Optometrist in Prudenville, MI
• Providers in Prudenville, MI by specialty
• Optometrist in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 5, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.