| NPI | 1265489777 |
|---|---|
| Doing Business As | LAKELINE VISION SOURCE |
| Entity Type | Organization |
| Authorized Contact | MICHELLE L WIGGINS Credentialing Manager 512-918-3937 |
| Organization Subpart ? | No |
| Primary Taxonomy | 152W00000X Optometrist |
| Enumeration Date | 2006-05-28 |
| Last Update Date | 2020-10-05 |