Healthcare Provider Details

I. General information

NPI: 1285565069
Provider Name (Legal Business Name): LAKE VISION PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/28/2026
Last Update Date: 05/28/2026
Certification Date: 05/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2510 MAPLE GROVE RD STE 500
DULUTH MN
55811-1829
US

IV. Provider business mailing address

2510 MAPLE GROVE RD STE 500
DULUTH MN
55811-1829
US

V. Phone/Fax

Practice location:
  • Phone: 218-722-2712
  • Fax: 218-722-1011
Mailing address:
  • Phone: 218-722-2712
  • Fax: 218-722-1011

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number
License Number State

VIII. Authorized Official

Name: AMY WALKOWIAK
Title or Position: OPTOMETRIST/OWNER
Credential: OD
Phone: 715-817-4393