| NPI | 1508402033 |
|---|---|
| Doing Business As | LAKE REGION EYE CENTER |
| Entity Type | Organization |
| Authorized Contact | GWEN K THOENNES Office Manager 320-763-7055 |
| Organization Subpart ? | No |
| Primary Taxonomy | 152W00000X Optometrist |
| Enumeration Date | 2019-11-19 |
| Last Update Date | 2019-11-19 |