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General NPI Number Information
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NPI Number | 1164597225
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Entity Type | Organization
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Legal Business Name | LAKEVIEW VISION CENTER, LLC
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Dates
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Enumeration Date | 11/22/2006
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Last Update Date | 11/19/2008
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Provider Practice Location Address
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Address Line | 628 N 1ST ST STE C
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City | LAKEVIEW
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State | OR
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Zip | 97630-1506
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Country | US
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Telephone | 541-947-3357
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Fax | 541-947-3368
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Provider Business Mailing Address
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Address Line | 628 N 1ST ST STE C
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City | LAKEVIEW
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State | OR
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Zip | 97630-1506
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Country | US
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Telephone | 541-947-3357
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Fax | 541-947-3368
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Authorized Official
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Title or Position | OWNER
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Name | DR. GARRY DWAYNE KAPPEL
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Credential | O D
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Telephone | 541-947-3357
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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 | 961ATI
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License Number State | OR
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