Michael S. Lackman, O.D.

Primary specialty

OptometristTaxonomy code 152W00000X

License

1856ATI Issued in OR

Practice address

65 Division Ave
Suite E
Eugene, OR 97404-2485

Phone

(541) 689-1115

Fax

(541) 688-5585

NPI assigned

Feb 10, 2006

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

Other identifiers 4

Medicare fee-for-service enrollment

Enrolled in OR

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

Pacific University - College of Optometry, 1986

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

The Eye Center LLCGroup PAC ID 3779556774, 4 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

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

• The Eye Center LLC

  • Ophthalmology Physician
  • Eugene, OR
  • NPI 1770664484
  Medicare reassignment Care Compare group NPD
• The Eye Center LLC

  • Optometrist
  • Eugene, OR
  • NPI 1245579994
  NPD
• The Eye Center LLC

  • Ophthalmology Physician
  • Newport, OR
  • NPI 1801059274
  NPD

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

{
    "created_epoch": "1139529600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1191974400000",
    "number": "1497728398",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "65 DIVISION AVE",
            "address_2": "SUITE E",
            "city": "EUGENE",
            "state": "OR",
            "postal_code": "974042485",
            "telephone_number": "541-689-1115",
            "fax_number": "541-688-5585"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "65 DIVISION AVE",
            "address_2": "SUITE E",
            "city": "EUGENE",
            "state": "OR",
            "postal_code": "974042485",
            "telephone_number": "541-689-1115",
            "fax_number": "541-688-5585"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LACKMAN",
        "first_name": "MICHAEL",
        "middle_name": "S.",
        "name_prefix": "Dr.",
        "credential": "O.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-02-10",
        "last_updated": "2007-10-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "OR",
            "license": "1856ATI",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "083019",
            "state": "OR"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PACIFIC SOURCE",
            "identifier": "02501-01",
            "state": "OR"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "EYEMED",
            "identifier": "111228",
            "state": "OR"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NORTHWEST BENEFIT NETWORK",
            "identifier": "3021",
            "state": "OR"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Laboratory Corporation of America
• Elizabeth Labosky
• Michael E Lacey, DMD
• Trisha Marie Lacey, PHYSICIAN ASSISTANT
• Eric A Lackie, LMFT
• Karen B Lackritz, LMT
• Kelly Laura Lacost, THW, PSS
• Crisselle Lacsina
• Kat Laferle (Aka Dolan), BS, CADC I
• Charity Anne Lafollette, LMT

• Optometrist in Eugene, OR
• Providers in Eugene, OR by specialty
• Optometrist in Oregon

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 10, 2007; 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.