Lakes Vision, PC

Primary specialty

OptometristTaxonomy code 152W00000X

License

2434 Issued in MN

Legal business name

LAKES VISION, PC

Practice address

1583 Highway 10 W
Detroit Lakes, MN 56501-2232

Phone

(218) 847-7245

Fax

(218) 847-8453

NPI assigned

Feb 8, 2010

Organization subpart

No

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

Authorized official

Name

Craig Allen Bratvold, O.D.

Title

Optometrist

Phone

(218) 849-4295

Specialties & licenses 1

Addresses

Other identifiers 1

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

{
    "created_epoch": "1265587200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1265587200000",
    "number": "1871825364",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "24226 RIDGEVIEW CIR",
            "city": "DETROIT LAKES",
            "state": "MN",
            "postal_code": "565017151",
            "telephone_number": "218-849-4295",
            "fax_number": "218-847-8453"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1583 HIGHWAY 10 W",
            "city": "DETROIT LAKES",
            "state": "MN",
            "postal_code": "565012232",
            "telephone_number": "218-847-7245",
            "fax_number": "218-847-8453"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LAKES VISION, PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2010-02-08",
        "last_updated": "2010-02-08",
        "status": "A",
        "authorized_official_last_name": "BRATVOLD",
        "authorized_official_first_name": "CRAIG",
        "authorized_official_middle_name": "ALLEN",
        "authorized_official_title_or_position": "OPTOMETRIST",
        "authorized_official_telephone_number": "218-849-4295",
        "authorized_official_credential": "O.D."
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Optometrist",
            "state": "MN",
            "license": "2434",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE PTAN",
            "identifier": "410003242",
            "state": "MN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Lakeridge Dental Partners, PLLC
• Lakes Country Healthcare P.L.L.C.
• Lakes Crisis & Resource Center
• Lakes Homes and Program Development, Inc.
• Lakes Medi-Van Inc.
• Lola S Lalonde
• A. Douglas Landers, MD
• Alyson Rose Larson, PHARMD
• Heather Larson, LGSW
• Jon D Larson, MD

• Optometrist in Detroit Lakes, MN
• Providers in Detroit Lakes, MN by specialty
• Optometrist in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 8, 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.