Lakeside Vision Inc

Primary specialty

OptometristTaxonomy code 152W00000X

License

MI2953 Issued in MI

Legal business name

LAKESIDE VISION INC

Practice address

888 W Houghton Lake Dr
Prudenville, MI 48651-9451

Phone

(989) 366-7525

Fax

(989) 366-5405

NPI assigned

Jun 9, 2005

Organization subpart

No

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

Authorized official

Name

Jennifer Boggs

Title

Office Manager

Phone

(989) 366-7525

Specialties & licenses 1

Addresses

Other identifiers 2

Practitioners 3

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Ryan Chrencik, OD

  • Optometrist
  • Louisville, KY
  • NPI 1487427316
  NPD
• David S Cook, O.D.

  • Optometrist
  • Cadillac, MI
  • NPI 1780753749
  NPD (past)
• Virginia Gilmore, O.D.

  • Optometrist
  • Bangor, ME
  • NPI 1821000258
  NPD (past)

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

{
    "created_epoch": "1118275200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1216166400000",
    "number": "1790789550",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "888 W HOUGHTON LAKE DR",
            "address_2": "P O BOX 20",
            "city": "PRUDENVILLE",
            "state": "MI",
            "postal_code": "486519451",
            "telephone_number": "989-366-7525",
            "fax_number": "989-366-5405"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "888 W HOUGHTON LAKE DR",
            "city": "PRUDENVILLE",
            "state": "MI",
            "postal_code": "486519451",
            "telephone_number": "989-366-7525",
            "fax_number": "989-366-5405"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LAKESIDE VISION INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-06-09",
        "last_updated": "2008-07-16",
        "status": "A",
        "authorized_official_last_name": "BOGGS",
        "authorized_official_first_name": "JENNIFER",
        "authorized_official_title_or_position": "OFFICE MANAGER",
        "authorized_official_telephone_number": "989-366-7525"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Optometrist",
            "state": "MI",
            "license": "MI2953",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1562533",
            "state": "MI"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS BLUE SHIELD",
            "identifier": "900G21001",
            "state": "MI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Casey Krajenka
• Kronner Pharmacy Inc
• Madison Leigh Kudla
• Emalee Katherine Lademan, RBT
• Kendra Lahaie
• Lakeside Vision, Prudenville, PC
• Michelle Ann Langusch, M.A.
• Courtenay Larkin
• Nichole Lynn Latowski
• Sheryl Ann Leonard

• Optometrist in Prudenville, MI
• Providers in Prudenville, MI by specialty
• Optometrist in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 16, 2008; 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.