Lost Lake Optical Company | |
5240 Shady Island Cir Mound MN 55364-9222 | |
(612) 670-8887 | |
(952) 474-1933 |
Full Name | Lost Lake Optical Company |
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Speciality | Clinic/center |
Location | 5240 Shady Island Cir, Mound, Minnesota |
Authorized Official Name and Position | Jay B. Petersen (OWNER) |
Authorized Official Contact | 6126708887 |
Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
Mailing Address | Practice Location Address |
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Lost Lake Optical Company 5240 Shady Island Cir Mound MN 55364-9222 Ph: (612) 670-8887 | Lost Lake Optical Company 5240 Shady Island Cir Mound MN 55364-9222 Ph: (612) 670-8887 |
NPI Number | 1003434622 |
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Provider Enumeration Date | 07/09/2020 |
Last Update Date | 09/04/2020 |
Identifier | Type | State | Issuer |
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1003434622 | NPI | - | NPPES |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
261Q00000X | Clinic/center | (* (Not Available)) | Primary |