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General NPI Number Information
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NPI Number | 1154414159
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Entity Type | Organization
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Legal Business Name | LAKELAND EYE CLINIC PA
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Dates
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Enumeration Date | 10/02/2006
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Last Update Date | 09/14/2022
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Provider Practice Location Address
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Address Line | 1247 LAKELAND HILLS BLVD
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City | LAKELAND
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State | FL
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Zip | 33805-4673
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Country | US
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Telephone | 863-688-5604
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Fax |
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Provider Business Mailing Address
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Address Line | 1247 LAKELAND HILLS BLVD
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City | LAKELAND
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State | FL
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Zip | 33805-4673
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Country | US
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Telephone | 863-688-5604
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | KEVIN A DORSETT
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Credential | MD
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Telephone | 863-688-5604
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 207W00000X
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Taxonomy Name | Ophthalmology Physician
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License Number |
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License Number State |
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