| NPI | 1043400062 |
|---|---|
| Doing Business As | LAKESIDE VISION & OPTICAL |
| Entity Type | Organization |
| Authorized Contact | STACY LYNN TURNER President 972-985-3638 |
| Organization Subpart ? | No |
| Primary Taxonomy | 302F00000X Exclusive Provider Organization |
| Enumeration Date | 2007-07-26 |
| Last Update Date | 2022-07-21 |