Lake Street Optical

Primary specialty

OptometristTaxonomy code 152W00000X

License

04607174 Issued in IL

Legal business name

LAKE STREET OPTICAL

Practice address

1036 N Lake St
Aurora, IL 60506-2467

Phone

(630) 892-0244

Fax

(630) 947-0419

NPI assigned

Jun 10, 2010

Organization subpart

No

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

Authorized official

Name

Dr. David D Dewaard, O.D.

Title

Owner

Phone

(630) 892-0244

Specialties & licenses 1

Addresses

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

{
    "created_epoch": "1276128000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1276128000000",
    "number": "1760702963",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1036 N LAKE ST",
            "city": "AURORA",
            "state": "IL",
            "postal_code": "605062467",
            "telephone_number": "630-892-0244",
            "fax_number": "630-947-0419"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1036 N LAKE ST",
            "city": "AURORA",
            "state": "IL",
            "postal_code": "605062467",
            "telephone_number": "630-892-0244",
            "fax_number": "630-947-0419"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LAKE STREET OPTICAL",
        "organizational_subpart": "NO",
        "enumeration_date": "2010-06-10",
        "last_updated": "2010-06-10",
        "status": "A",
        "authorized_official_last_name": "DEWAARD",
        "authorized_official_first_name": "DAVID",
        "authorized_official_middle_name": "D",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "630-892-0244",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "O.D."
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Optometrist",
            "state": "IL",
            "license": "04607174",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Danielle Dawn La Ha, M.A.
• Elizabeth Rebecca La Ha
• Robert A Labak, MSSW, LCSW
• Rosalva Lacke
• Jo Ann Jaen Lagman, M.D.
• Tiffany Lake-Luckett
• Kamala Lakshmipathy
• Mary Ellen Laloggia, M.A,
• Deanna Marie Lamartina, CPNP-PC
• Ryan Lambe, PT, DPT

• Optometrist in Aurora, IL
• Providers in Aurora, IL by specialty
• Optometrist in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 10, 2010; 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.