Healthcare Provider Details

I. General information

NPI: 1346253408
Provider Name (Legal Business Name): MICHAEL LAIR OD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/13/2006
Last Update Date: 10/04/2022
Certification Date: 10/04/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

400 EAST FIRST STREET
MORRIS MN
56267-0660
US

IV. Provider business mailing address

400 E 1ST ST
MORRIS MN
56267-1408
US

V. Phone/Fax

Practice location:
  • Phone: 320-589-1313
  • Fax: 320-589-3533
Mailing address:
  • Phone: 320-589-1313
  • Fax: 320-589-1065

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number1949
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: