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General NPI Number Information
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NPI Number | 1376412684
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Entity Type | Organization
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Legal Business Name | LAKES REGION RETINA PC
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Dates
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Enumeration Date | 11/04/2025
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Last Update Date | 12/10/2025
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Provider Practice Location Address
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Address Line | 13800 BLUESTEM CT
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City | BAXTER
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State | MN
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Zip | 56425
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Country | US
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Telephone | 218-580-4218
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Fax | 218-580-4218
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Provider Business Mailing Address
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Address Line | 5014 WOODHURST LN
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City | MINNETONKA
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State | MN
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Zip | 55345-4644
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Country | US
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Telephone | 612-382-8535
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Fax |
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Authorized Official
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Title or Position | OWNER, CEO, PRESIDENT
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Name | DAVID F WILLIAMS
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Credential | M.D.
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Telephone | 612-382-8535
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207WX0107X
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Taxonomy Name | Retina Specialist (Ophthalmology) Physician
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License Number |
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License Number State |
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