NPIMap

Organization Active NPI

Lakeline Vision, P.C.

Doing business as Lakeline Vision Source

  • Optometrist
  • Cedar Park, TX
National Provider Identifier
1265489777
Registry record updated Oct 5, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
OptometristTaxonomy code 152W00000X
Legal business name
LAKELINE VISION, P.C.
Doing business as
Lakeline Vision Source
Practice address
3419 El Salido Pkwy Ste 100
Cedar Park, TX 78613-5639
Phone
(512) 918-3937
Fax
(512) 918-2028
NPI assigned
May 28, 2006
Last updated
Oct 5, 2020By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 5, 2020

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

Authorized official

Name
Michelle L Wiggins
Title
Credentialing Manager
Phone
(512) 918-3937

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Optometrist 152W00000X Primary

Addresses

Primary practice location

3419 El Salido Pkwy Ste 100
Cedar Park, TX 78613-5639

Mailing address

3419 El Salido Pkwy Ste 100
Cedar Park, TX 78613-5639
Phone (512) 918-3937

Other names 1

  • Lakeline Vision Source Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20040428001473 TX Part B Supplier - Clinic/Group Practice 0244227486 Receives reassigned benefits from 10 practitioners
Practice locations: Cedar Park, TX

National Provider Directory

National Provider Directory

Locations

12233 Ranch Road 620 N
Ste 103
Austin, TX 78750
Phone (512) 918-3937

3419 El Salido Pkwy
Ste 100
Cedar Park, TX 78613
Phone (512) 918-3937

Practitioners & affiliated clinicians

Practitioners 13

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.

View all 13

NPI Registry JSON

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

{
    "created_epoch": "1148774400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1601856000000",
    "number": "1265489777",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3419 EL SALIDO PKWY STE 100",
            "city": "CEDAR PARK",
            "state": "TX",
            "postal_code": "786135639",
            "telephone_number": "512-918-3937",
            "fax_number": "512-918-2028"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3419 EL SALIDO PKWY STE 100",
            "city": "CEDAR PARK",
            "state": "TX",
            "postal_code": "786135639",
            "telephone_number": "512-918-3937",
            "fax_number": "512-918-2028"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LAKELINE VISION, P.C.",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-05-28",
        "last_updated": "2020-10-05",
        "certification_date": "2020-10-05",
        "status": "A",
        "authorized_official_last_name": "WIGGINS",
        "authorized_official_first_name": "MICHELLE",
        "authorized_official_middle_name": "L",
        "authorized_official_title_or_position": "CREDENTIALING MANAGER",
        "authorized_official_telephone_number": "512-918-3937"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Lakeline Vision Source",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Lakeline Vision Source",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Cedar Park, TX

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 5, 2020; 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.