| NPI | 1871775973 |
|---|---|
| Doing Business As | LAKESHORE OPTICAL |
| Entity Type | Organization |
| Authorized Contact | ROBERT SISSON BUSCH President 480-839-3711 |
| Organization Subpart ? | No |
| Primary Taxonomy | 156FX1800X Technician/Technologist, Optician (Licence: AZ 286) |
| Enumeration Date | 2007-11-29 |
| Last Update Date | 2007-11-29 |