Richard B Lake, O.D.

Primary specialty

OptometristTaxonomy code 152W00000X

License

OP1036 Issued in FL

Practice address

6027 Cypress Gardens Blvd
Winter Haven, FL 33884-4115

Phone

(863) 326-5824

NPI assigned

Jul 1, 2005

Last updated

Aug 21, 2007By the provider in NPPES

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

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

{
    "created_epoch": "1120176000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1187654400000",
    "number": "1255338513",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "685 SHANKLIN AVE",
            "city": "BARTOW",
            "state": "FL",
            "postal_code": "338304335",
            "telephone_number": "863-533-1363"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6027 CYPRESS GARDENS BLVD",
            "city": "WINTER HAVEN",
            "state": "FL",
            "postal_code": "338844115",
            "telephone_number": "863-326-5824"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LAKE",
        "first_name": "RICHARD",
        "middle_name": "B",
        "name_prefix": "Dr.",
        "credential": "O.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2005-07-01",
        "last_updated": "2007-08-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "FL",
            "license": "OP1036",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Lakeland Family Pharmacy
• Lakeland Home Care Services, LLC (Mederi Caretenders)
• Lakeland Regional Health System, Inc.
• Lakeland Regional Health Systems, Inc.
• Lakeland Regional Health Systems, Inc.

• Optometrist in Winter Haven, FL
• Providers in Winter Haven, FL by specialty
• Optometrist in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 21, 2007; 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.