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General NPI Number Information
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NPI Number | 1457186850
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Entity Type | Organization
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Legal Business Name | BLUE LAKES EYE CARE, PLLC
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Dates
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Enumeration Date | 09/04/2024
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Last Update Date | 03/18/2025
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Provider Practice Location Address
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Address Line | 855 VIKINGS PKWY STE B
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City | EAGAN
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State | MN
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Zip | 55121-1139
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Country | US
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Telephone | 651-280-4420
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Fax | 651-280-4115
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Provider Business Mailing Address
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Address Line | 855 VIKINGS PKWY STE B
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City | EAGAN
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State | MN
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Zip | 55121-1187
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Country | US
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Telephone | 651-280-4420
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Fax | 651-280-4115
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Authorized Official
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Title or Position | DOCTOR/OWNER
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Name | EMILY KAY BJORE
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Credential | OD
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Telephone | 651-280-4420
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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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