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General NPI Number Information
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NPI Number | 1396929527
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Entity Type | Organization
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Legal Business Name | OWOSSO FAMILY OPTOMETRY CENTER PC
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Dates
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Enumeration Date | 12/24/2007
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Last Update Date | 04/01/2008
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Provider Practice Location Address
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Address Line | 311 E MAIN ST
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City | OWOSSO
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State | MI
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Zip | 48867-3136
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Country | US
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Telephone | 989-725-2311
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Fax | 989-725-6055
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Provider Business Mailing Address
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Address Line | 311 E MAIN ST
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City | OWOSSO
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State | MI
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Zip | 48867-3136
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Country | US
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Telephone | 989-725-2311
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Fax | 989-725-6055
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Authorized Official
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Title or Position | OWNER
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Name | DR. WALTER J LASOVAGE
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Credential | O.D.
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Telephone | 989-725-2311
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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 | 2016491
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License Number State | MI
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