Lake Tahoe Eye Care Optometry Inc
Organization Active NPI Optometrist · So Lake Tahoe, CA
NPI 1831252808 · NPPES record last updated Sep 19, 2008
Key facts
- NPI
- 1831252808
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Optometrist 152W00000X
- License
- COR53 (CA)
- Legal business name
- LAKE TAHOE EYE CARE OPTOMETRY INC
- Practice address
- 2074 Lake Tahoe Blvd
Suite 2
So Lake Tahoe, CA 96150-6408 - Phone
- (530) 541-2030
- Fax
- (530) 541-3947
- NPI assigned
- Dec 19, 2006
- Organization subpart
- No
Authorized official
- Name
- Mark M Lehmann, OD
- Title
- V Pres Secy
- Phone
- (530) 541-2030
Practitioners 4
-
Paul W. Hiss, M.D.
-
Robert Steven Wolff, M.D.
Laboratory certificates & supplier records
Medicare medical equipment & supply locations
| Supplier | Supplies | Medicare assignment |
|---|---|---|
| Lake Tahoe Eye Care Optometry |
Prosthetic Lenses: Conventional Eyeglasses|Prosthetic Lenses: Conventional Contact Lenses|Prosthetic Lenses: Prosthetics Cataract Lenses | Accepts assignment |
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled (2 enrollments) in CA
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20080207000593 | CA | Part B Supplier - Clinic/Group Practice | 8022191402 |
Receives reassigned benefits from 2 practitioners Practice locations: S Lake Tahoe, CA |
| O20100930097867 | CA | DME Supplier - Physician - Optometrist | 8022191402 | Practice locations: South Lake Tahoe, CA |
National Provider Directory
Locations
2074 Lake Tahoe Blvd
Ste 2
South Lake Tahoe, CA 96150
Phone (530) 541-2030
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Optometrist |
152W00000X | COR53 | CA | Yes |
Addresses
Primary practice location
2074 Lake Tahoe Blvd
Suite 2
So Lake Tahoe, CA 96150-6408
Mailing address
2074 Lake Tahoe Blvd
Suite 2
So Lake Tahoe, CA 96150-6408
Phone (530) 541-2030
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| ZZZ75623Z | Other | MEDICARE GROUP PROVIDER # | |
| GSD000760 | Medicaid | CA |
Other providers in So Lake Tahoe, CA
- Richard Joseph Beck
- Holly L Cook
- Katie Anne Harrison
- Michael Charles Lipkin
- Steven J. McNamara
- Kenneth D Rumack
- Michael Patrick Sullivan
All providers in So Lake Tahoe, CA · Optometrist in California
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Sep 19, 2008. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.