Healthcare Provider Details

I. General information

NPI: 1326091521
Provider Name (Legal Business Name): RAYMOND A LALONDE O.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/18/2006
Last Update Date: 12/14/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1948 N HURON RD
PINCONNING MI
48650-7909
US

IV. Provider business mailing address

PO BOX 325
PINCONNING MI
48650-0325
US

V. Phone/Fax

Practice location:
  • Phone: 989-879-3937
  • Fax: 989-879-3981
Mailing address:
  • Phone: 989-879-3937
  • Fax: 989-879-3981

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License NumberRL003052
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: