Lake Optometric Vision PA – Optometrist

Key facts

NPI: 1831356773
Entity type: Organization (NPI type 2)
Primary specialty: Optometrist 152W00000X
License: 2142 (MN)
Legal business name: LAKE OPTOMETRIC VISION PA
Practice address: 12700 Lake Blvd
Lindstrom, MN 55045
Phone: (651) 257-2419
Fax: (651) 257-2419
NPI assigned: May 19, 2008
Organization subpart: No

Authorized official

Name: Dr. Vernon Bruce Lovdokken, OD NPI 1861534315
Title: Owner
Phone: (651) 257-2419

Authorized official NPPES reports the authorized official by name only; the link goes to the one practitioner connected to this organization with that name.

Practitioners 1

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

Vernon Bruce Lovdokken, OD Optometrist · Lindstrom, MN · NPI 1861534315

NPD Authorized official OPTOMETRIST

National Provider Directory

Specialties & licenses

Specialty (taxonomy)	Code	License	State	Primary
Optometrist Group: 193400000X SINGLE SPECIALTY GROUP	152W00000X	2142	MN	Yes

Addresses

Primary practice location

12700 Lake Blvd
Lindstrom, MN 55045

Mailing address

12700 Lake Blvd
Box 552
Lindstrom, MN 55045
Phone (651) 257-2419

Other identifiers

Identifier	Type	State	Issuer
59389LO	Other	MN	BLUE CROSS BLUE SHIELD
628823500	Medicaid	MN
1861534315	Other	MN	HEALTHPARTNERS
45964	Other	MN	PREFERREDONE
2214338	Other	MN	MEDICA

Other names

lindstrom optical Doing business as

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API JSON format, last updated by the provider on May 19, 2008.

{
    "created_epoch": "1211155200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1211155200000",
    "number": "1831356773",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "12700 LAKE BLVD",
            "address_2": "BOX 552",
            "city": "LINDSTROM",
            "state": "MN",
            "postal_code": "55045",
            "telephone_number": "651-257-2419",
            "fax_number": "651-257-2419"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "12700 LAKE BLVD",
            "city": "LINDSTROM",
            "state": "MN",
            "postal_code": "55045",
            "telephone_number": "651-257-2419",
            "fax_number": "651-257-2419"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LAKE OPTOMETRIC VISION PA",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-05-19",
        "last_updated": "2008-05-19",
        "status": "A",
        "authorized_official_last_name": "LOVDOKKEN",
        "authorized_official_first_name": "VERNON",
        "authorized_official_middle_name": "BRUCE",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "651-257-2419",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "OD"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Optometrist",
            "state": "MN",
            "license": "2142",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS BLUE SHIELD",
            "identifier": "59389LO",
            "state": "MN"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "628823500",
            "state": "MN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "HEALTHPARTNERS",
            "identifier": "1861534315",
            "state": "MN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PREFERREDONE",
            "identifier": "45964",
            "state": "MN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICA",
            "identifier": "2214338",
            "state": "MN"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "lindstrom optical",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Lindstrom, MN

All providers in Lindstrom, MN · Optometrist in Minnesota

Sources for this page

NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on May 19, 2008. Information in NPPES is self-reported and not verified by CMS.
NUCC Health Care Provider Taxonomy: specialty names.
National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.