Healthcare Provider Details

I. General information

NPI: 1386626794
Provider Name (Legal Business Name): ALBERT RAY LAMOTTE OD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/20/2005
Last Update Date: 09/18/2025
Certification Date: 09/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 AMERICAN BLVD W
BLOOMINGTON MN
55420-1120
US

IV. Provider business mailing address

5009 EVEREST LN N
PLYMOUTH MN
55446-4520
US

V. Phone/Fax

Practice location:
  • Phone: 952-888-6110
  • Fax:
Mailing address:
  • Phone: 612-701-7064
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number1893
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: