| NPI | 1407059678 |
|---|---|
| Former Legal Business Name | LAKEVILLE FAMILY EYE CARE PA |
| Entity Type | Organization |
| Authorized Contact | ANDREW JOSEPH MATTSON President 952-898-9588 |
| Organization Subpart ? | No |
| Primary Taxonomy | 152W00000X Optometrist |
| Enumeration Date | 2007-06-06 |
| Last Update Date | 2011-06-02 |