Healthcare Provider Details

I. General information

NPI: 1043400062
Provider Name (Legal Business Name): LAKESIDE VISION & OPTICAL P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/26/2007
Last Update Date: 01/07/2025
Certification Date: 01/07/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4012 PRESTON ROAD SUITE 500
PLANO TX
75093-7351
US

IV. Provider business mailing address

4012 PRESTON RD STE 500
PLANO TX
75093-7351
US

V. Phone/Fax

Practice location:
  • Phone: 872-985-3638
  • Fax: 972-867-7062
Mailing address:
  • Phone: 972-985-3638
  • Fax: 972-867-7062

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152WC0802X
TaxonomyCorneal and Contact Management Optometrist
License Number
License Number State

VIII. Authorized Official

Name: DR. STACY LYNN TURNER
Title or Position: PRESIDENT
Credential: O.D.
Phone: 972-985-3638