Lakes Optometry Clinic PLLC

Primary specialty

OptometristTaxonomy code 152W00000X

License

2773 Issued in MN

Legal business name

LAKES OPTOMETRY CLINIC PLLC

Practice address

308 5TH Ave S
Suite 110
Cold Spring, MN 56320-2343

Phone

(320) 685-5400

NPI assigned

Jun 29, 2006

Organization subpart

No

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

Authorized official

Name

Mary Jo Janet Femrite, OPTOMETRIST

Title

President

Phone

(320) 685-5400

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• LAKES Eye Clinic Doing business as

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

{
    "created_epoch": "1151539200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1420675200000",
    "number": "1487682126",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "308 5TH AVE S",
            "address_2": "SUITE 110",
            "city": "COLD SPRING",
            "state": "MN",
            "postal_code": "563202343",
            "telephone_number": "320-685-5400"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "308 5TH AVE S",
            "address_2": "SUITE 110",
            "city": "COLD SPRING",
            "state": "MN",
            "postal_code": "563202343",
            "telephone_number": "320-685-5400"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LAKES OPTOMETRY CLINIC PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-06-29",
        "last_updated": "2015-01-08",
        "status": "A",
        "authorized_official_last_name": "FEMRITE",
        "authorized_official_first_name": "MARY JO",
        "authorized_official_middle_name": "JANET",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "320-685-5400",
        "authorized_official_credential": "OPTOMETRIST"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Optometrist",
            "state": "MN",
            "license": "2773",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "490132100",
            "state": "MN"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "LAKES Eye Clinic",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Suzanne Kelly, CNP
• Charles Anton Kinzer, DC
• Melissa Jane Kron, LMFT
• Megan Ann Kropuenske, PHARMD
• Kyler Meers MSW Licsw, Inc.
• Cassandra Michelle Lehn, P.A.
• Darian Kay Lindsay, DC
• Kathryn Linnemann, RN
• Adam Roy Lubbers, M.P.T.
• Brandi Rae Marten

• All providers in Cold Spring, MN
• Optometrist in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 8, 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.