Healthcare Provider Details

I. General information

NPI: 1174750046
Provider Name (Legal Business Name): LAURA L LOKEY O.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/17/2009
Last Update Date: 06/17/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1335 UNION AVE NE
GRAND RAPIDS MI
49505-5105
US

IV. Provider business mailing address

1335 UNION AVE NE
GRAND RAPIDS MI
49505-5105
US

V. Phone/Fax

Practice location:
  • Phone: 616-458-2430
  • Fax:
Mailing address:
  • Phone: 616-458-2430
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number3144-35
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: