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NPI Code Detail

MEDICARE: BLUE LAKES EYE CARE, PLLC

MEDICARE: BLUE LAKES EYE CARE, PLLC
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
1152W00000XOptometrist

General Provider Information

NPI Number : 1457186850
Entity Type Code : Organization
Provider Name (Legal Business Name) : BLUE LAKES EYE CARE, PLLC
Provider Business Mailing Address
First Line : 855 VIKINGS PKWY STE B
Second Line :
City : EAGAN
State : MN
Zip : 55121-1187
Country : US
Telephone Number : 651-280-4420
Fax Number : 651-280-4115
Provider Business Practice Location Address
First Line : 855 VIKINGS PKWY STE B
Second Line :
City : EAGAN
State : MN
Zip : 55121-1139
Country : US
Telephone Number : 651-280-4420
Fax Number : 651-280-4115
Authorized Official
Title or Position : ACCTS
Name : DOREEN BOELTER
Credential :
Telephone Number : 651-503-5463
Provider Enumeration Date : 09/04/2024
Last Update Date : 02/09/2026

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Directions to “BLUE LAKES EYE CARE, PLLC ” Practice Location

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