Lakeside Optical Inc

Primary specialty

OpticianTaxonomy code 156FX1800X

License

OE 0000300 Issued in FL

Legal business name

LAKESIDE OPTICAL INC

Practice address

6595 Seminole Blvd
Seminole, FL 33772-6314

Phone

(727) 398-7500

Fax

(727) 398-4851

NPI assigned

Jun 2, 2006

Organization subpart

No

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

Authorized official

Name

Bethany Kay Allen, LDO

Title

President

Phone

(727) 398-7500

Specialties & licenses 1

Addresses

Other identifiers 2

Locations

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

{
    "created_epoch": "1149206400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1328054400000",
    "number": "1699712067",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6595 SEMINOLE BLVD",
            "city": "SEMINOLE",
            "state": "FL",
            "postal_code": "337726314",
            "telephone_number": "727-398-7500",
            "fax_number": "727-398-4851"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6595 SEMINOLE BLVD",
            "city": "SEMINOLE",
            "state": "FL",
            "postal_code": "337726314",
            "telephone_number": "727-398-7500",
            "fax_number": "727-398-4851"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LAKESIDE OPTICAL INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-06-02",
        "last_updated": "2012-02-01",
        "status": "A",
        "authorized_official_last_name": "ALLEN",
        "authorized_official_first_name": "BETHANY",
        "authorized_official_middle_name": "KAY",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "727-398-7500",
        "authorized_official_credential": "LDO"
    },
    "taxonomies": [
        {
            "code": "156FX1800X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Technician/Technologist, Optician",
            "state": "FL",
            "license": "OE 0000300",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BC/BS FL SUPPLIER NUMBER",
            "identifier": "D7661",
            "state": "FL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PALMETTO  EDI SUBMITTER #",
            "identifier": "C08421572",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Jennifer L'Eon
• L&C Wellness Center LLC
• Charles H Lacoste, DC
• Lake Balaton, Inc.
• Lake Seminole Square Management Company, LLC
• Peter S Lally, RPT
• Allen Dwayne Lamasco
• Amanda Marie Laurenzo, PHARM D
• Keanan Lawrence, AGACNP-BC
• Thanh Thien Le, MD

• Optician in Seminole, FL
• Providers in Seminole, FL by specialty
• Optician in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 1, 2012; 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.