MEDICARE: NORTH LAKE EYECARE OPTOMETRY

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	152W00000X	Optometrist	9655T	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1447580360
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NORTH LAKE EYECARE OPTOMETRY

Provider Business Mailing Address
First Line	:	PO BOX 7170
Second Line	:
City	:	TAHOE CITY
State	:	CA
Zip	:	96145-7170
Country	:	US
Telephone Number	:	530-583-5004
Fax Number	:	530-583-0217

Provider Business Practice Location Address
First Line	:	1225 N LAKE BLVD
Second Line	:
City	:	TAHOE CITY
State	:	CA
Zip	:	96145-7170
Country	:	US
Telephone Number	:	530-583-5004
Fax Number	:	530-583-0217

Authorized Official
Title or Position	:	OPTOMETRIST/OWNER
Name	:	DR. MARGARET D RAULINO
Credential	:	O.D.
Telephone Number	:	530-583-5004

Provider Enumeration Date	:	12/29/2009
Last Update Date	:	03/08/2011

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1902862212 — MARGARET D. RAULINO O.D.
Practice Location Address:

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1538268529 — DR. CHRISTOPHER JOSEPH GARRETT M.D.
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1386837391 — CHRISTOPHER J GARRETT LTD
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Practice Location Address:

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1306080734 — PERSONALIZED DENTAL CENTER
Practice Location Address:

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1548595796 — JOSEPH F GAZARKIEWICZ PSY.D
Practice Location Address:

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Directions to “NORTH LAKE EYECARE OPTOMETRY ” Practice Location

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