Susan Lake, O.D.

Primary specialty

Vision Therapy OptometristTaxonomy code 152WV0400X

License

T03457 Issued in MO

Practice address

601 E Russell Ave
Suite a
Warrensburg, MO 64093-9605

Phone

(660) 747-2020

Fax

(660) 747-0574

NPI assigned

May 19, 2006

Last updated

Jun 18, 2008By the provider in NPPES

Sex

Female

Sole proprietor

No

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

Enrolled in MO

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: No
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Specialty

Optometry

Education

Southern College of Optometry, 1999

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Eyecare Specialties of Missouri LLCGroup PAC ID 9931421187, 12 clinicians

Practice addresses (Care Compare)

Procedures performed for Medicare patients

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Eyecare Specialties of Missouri LLC

  dba Eyecare Specialites

  • Optometrist
  • Warrensburg, MO
  • NPI 1730596248
  Medicare reassignment Care Compare group
• Eyecare Specialties of Missouri LLC

  dba Eyecare Specialties

  • Optometrist
  • Sedalia, MO
  • NPI 1053482711
  NPD (past)

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

{
    "created_epoch": "1147996800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1213747200000",
    "number": "1285687210",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "601 E RUSSELL AVE",
            "address_2": "SUITE A",
            "city": "WARRENSBURG",
            "state": "MO",
            "postal_code": "640939605",
            "telephone_number": "660-747-2020",
            "fax_number": "660-747-0574"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "601 E RUSSELL AVE",
            "address_2": "SUITE A",
            "city": "WARRENSBURG",
            "state": "MO",
            "postal_code": "640939605",
            "telephone_number": "660-747-2020",
            "fax_number": "660-747-0574"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LAKE",
        "first_name": "SUSAN",
        "name_prefix": "Dr.",
        "credential": "O.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-05-19",
        "last_updated": "2008-06-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152WV0400X",
            "taxonomy_group": "",
            "desc": "Optometrist, Vision Therapy",
            "state": "MO",
            "license": "T03457",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Thomas Krause, DPT
• Logan Marie Kroenke, PT, DPT
• Laboratory Corporation of America Holdings
• Lake and Lake Optometry PC (Eyecare Specialties)
• Jason S. Lake, O.D.
• Lawrence Paul Landwehr, M.D.
• Mallory Langkrahr, LCSW
• Courtney Ann Langston, LCSW
• Lindsay Ann Lawrence, DPT, ATC
• Charles M Lederer Jr., M.D.

• Vision Therapy Optometrist in Warrensburg, MO
• Providers in Warrensburg, MO by specialty
• Vision Therapy Optometrist in Missouri

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 18, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.