Organization Active NPI

Lakeside Vision & Optical P.C.

  • Corneal and Contact Management Optometrist
  • Plano, TX
National Provider Identifier
1043400062
Registry record updated Jan 7, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Corneal and Contact Management OptometristTaxonomy code 152WC0802X
Legal business name
LAKESIDE VISION & OPTICAL P.C.
Doing business as
Lakeside Vision & Optical P.C.
Practice address
4012 Preston Road
Suite 500
Plano, TX 75093-7351
Phone
(872) 985-3638
Fax
(972) 867-7062
NPI assigned
Jul 26, 2007
Last updated
Jan 7, 2025By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 7, 2025

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

Authorized official

Name
Dr. Stacy Lynn Turner, O.D.
Title
President
Phone
(972) 985-3638

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Corneal and Contact Management Optometrist 152WC0802X NU Primary

Addresses

Primary practice location

4012 Preston Road
Suite 500
Plano, TX 75093-7351

Mailing address

4012 Preston Rd Ste 500
Plano, TX 75093-7351
Phone (972) 985-3638

Other names 1

  • Lakeside Vision & Optical P.C. Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in TX

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20050317000693 TX Part B Supplier - Clinic/Group Practice 1557316072 Receives reassigned benefits from 1 practitioner
Practice locations: Plano, TX

National Provider Directory

National Provider Directory

Locations

4012 Preston Rd
Ste 400
Plano, TX 75093
Phone (972) 985-3638

4012 Preston Rd
Ste 500
Plano, TX 75093
Phone (972) 985-3638

Practitioners & affiliated clinicians

Practitioners 3

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1185408000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1736208000000",
    "number": "1043400062",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4012 PRESTON RD STE 500",
            "city": "PLANO",
            "state": "TX",
            "postal_code": "750937351",
            "telephone_number": "972-985-3638",
            "fax_number": "972-867-7062"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4012 PRESTON ROAD",
            "address_2": "SUITE 500",
            "city": "PLANO",
            "state": "TX",
            "postal_code": "750937351",
            "telephone_number": "872-985-3638",
            "fax_number": "972-867-7062"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LAKESIDE VISION & OPTICAL P.C.",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-07-26",
        "last_updated": "2025-01-07",
        "certification_date": "2025-01-07",
        "status": "A",
        "authorized_official_last_name": "TURNER",
        "authorized_official_first_name": "STACY",
        "authorized_official_middle_name": "LYNN",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "972-985-3638",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "O.D."
    },
    "taxonomies": [
        {
            "code": "152WC0802X",
            "taxonomy_group": "",
            "desc": "Optometrist, Corneal and Contact Management",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Lakeside Vision & Optical P.C.",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Plano, TX

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 7, 2025; 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.