Lakeshore Eye Clinic PC

Primary specialty

OptometristTaxonomy code 152W00000X

License

4901004653 Issued in MI

Legal business name

LAKESHORE EYE CLINIC PC

Practice address

2500 7TH Ave S
217 Ste
Escanaba, MI 49829-1176

Phone

(906) 789-1400

Fax

(906) 789-3457

NPI assigned

Jul 1, 2014

Organization subpart

No

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

Authorized official

Name

Dr. Andrea Mott, O.D.

Title

Owner/President

Phone

(906) 789-1400

Specialties & licenses 1

Addresses

Other identifiers 1

Practitioners 1

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.

• Dale W Muth, O.D.

  • Optometrist
  • Newberry, MI
  • NPI 1659380293
  NPD (past)

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

{
    "created_epoch": "1404172800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1449705600000",
    "number": "1265847073",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2500 7TH AVE S",
            "address_2": "217 STE",
            "city": "ESCANABA",
            "state": "MI",
            "postal_code": "498291176",
            "telephone_number": "906-789-1400",
            "fax_number": "906-789-3457"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2500 7TH AVE S",
            "address_2": "217 STE",
            "city": "ESCANABA",
            "state": "MI",
            "postal_code": "498291176",
            "telephone_number": "906-789-1400",
            "fax_number": "906-789-3457"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LAKESHORE EYE CLINIC PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-07-01",
        "last_updated": "2015-12-10",
        "status": "A",
        "authorized_official_last_name": "MOTT",
        "authorized_official_first_name": "ANDREA",
        "authorized_official_title_or_position": "OWNER/PRESIDENT",
        "authorized_official_telephone_number": "906-789-1400",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "O.D."
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Optometrist",
            "state": "MI",
            "license": "4901004653",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS",
            "identifier": "900B10059",
            "state": "MI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Justin J Lacrosse, DO
• Tonya Lafave, R.D.
• Tori Ann Lafleur, MD
• Stacy Marrie Lake
• Lakeshore Chiropractic Center, P.C.
• Lakestate Industries
• Shayne R Lamarch, RD
• Meghan Lamarche
• Nathan Lambert
• Linda A Lanasa, PA

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

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 10, 2015; 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.