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General NPI Number Information
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NPI Number | 1811191513
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Entity Type | Organization
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Legal Business Name | L.C. OPTOMETRIC P.C.
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Dates
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Enumeration Date | 06/14/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 12131 ELM CREEK BLVD N
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City | MAPLE GROVE
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State | MN
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Zip | 55369-7093
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Country | US
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Telephone | 763-416-1983
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Fax | 763-416-4084
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Provider Business Mailing Address
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Address Line | 12131 ELM CREEK BLVD N
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City | MAPLE GROVE
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State | MN
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Zip | 55369-7093
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Country | US
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Telephone | 763-416-1983
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Fax | 763-416-4084
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Authorized Official
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Title or Position | OWNER
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Name | MR. ANTHONY LOVCIK
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Credential | O.D.
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Telephone | 763-416-1983
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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 | 2638
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License Number State | MN
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