Lakeside Optical Dispensary, Inc.

Primary specialty

OpticianTaxonomy code 156FX1800X

Legal business name

LAKESIDE OPTICAL DISPENSARY, INC.

Practice address

1020 W Ivy Ave
Moses Lake, WA 98837-2049

Phone

(509) 765-3497

Fax

(509) 765-5082

NPI assigned

Apr 14, 2006

Last updated

Aug 22, 2020By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Mr. Kevin Carvo

Title

President

Phone

(509) 765-3497

Specialties & licenses 1

Addresses

Other identifiers 2

Medicare fee-for-service enrollment

Enrolled in WA

Enrollment records 1

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

Medicare medical equipment & supply locations

Locations

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

{
    "created_epoch": "1144972800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1780648824",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1020 W IVY AVE",
            "city": "MOSES LAKE",
            "state": "WA",
            "postal_code": "988372049",
            "telephone_number": "509-765-3497",
            "fax_number": "509-765-5082"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1020 W IVY AVE",
            "city": "MOSES LAKE",
            "state": "WA",
            "postal_code": "988372049",
            "telephone_number": "509-765-3497",
            "fax_number": "509-765-5082"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LAKESIDE OPTICAL DISPENSARY, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-04-14",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "CARVO",
        "authorized_official_first_name": "KEVIN",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "509-765-3497",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "156FX1800X",
            "taxonomy_group": "",
            "desc": "Technician/Technologist, Optician",
            "state": "WA",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "2521003",
            "state": "WA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "L & I",
            "identifier": "0016601",
            "state": "WA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Sarah Kuismi
• Amber Kuntz
• Nicole Christine Labban, DO
• Laboratory Corporation of America
• Lakeside Dental
• Laketown Pharmacy PLLC (Laketown Pharmacy)
• Meghan Lamb, MSW, LICSWA
• Thomas Joachim Laney, D.D.S. , M.D.
• Jay R Lapratt
• Andrew Lapray, DMD

• Optician in Moses Lake, WA
• Providers in Moses Lake, WA by specialty
• Optician in Washington

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• 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.