Lakeline Medical Supply

Primary specialty

Durable Medical Equipment & Medical SuppliesTaxonomy code 332B00000X

License

0103078 Issued in TX

Legal business name

LAKELINE MEDICAL SUPPLY

Practice address

1525 Cypress Creek Rd Ste H
Cedar Park, TX 78613-3604

Phone

(512) 633-5669

Fax

(512) 401-2145

NPI assigned

Mar 25, 2008

Organization subpart

No

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

Authorized official

Name

Tyson Jon Krugman, DC

Title

Owner

Phone

(512) 633-5669

Specialties & licenses 1

Addresses

Locations

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

{
    "created_epoch": "1206403200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1206403200000",
    "number": "1043482540",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1525 CYPRESS CREEK RD STE H",
            "city": "CEDAR PARK",
            "state": "TX",
            "postal_code": "786133604",
            "telephone_number": "512-633-5669",
            "fax_number": "512-401-2145"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1525 CYPRESS CREEK RD STE H",
            "city": "CEDAR PARK",
            "state": "TX",
            "postal_code": "786133604",
            "telephone_number": "512-633-5669",
            "fax_number": "512-401-2145"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LAKELINE MEDICAL SUPPLY",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-03-25",
        "last_updated": "2008-03-25",
        "status": "A",
        "authorized_official_last_name": "KRUGMAN",
        "authorized_official_first_name": "TYSON",
        "authorized_official_middle_name": "JON",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "512-633-5669",
        "authorized_official_credential": "DC"
    },
    "taxonomies": [
        {
            "code": "332B00000X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies",
            "state": "TX",
            "license": "0103078",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Lakeline Eye Center
• Lakeline Eyecare PLLC
• Lakeline Family Dental
• Lakeline Mall Family Dental
• Lakeline Mall FDC PA
• Lakeline Outpatient Care PLLC
• Lakeline Vision, P.C.
• Catherine Lambert, MA, LPCA
• Monica Lane, FNP-BC
• Thomas Lanford

• Durable Medical Equipment & Medical Supplies in Cedar Park, TX
• Providers in Cedar Park, TX by specialty
• Durable Medical Equipment & Medical Supplies in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 25, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.