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General NPI Number Information
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NPI Number | 1851438543
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Entity Type | Organization
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Legal Business Name | LAKES REGION OPTICIANS, INC
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Dates
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Enumeration Date | 01/31/2007
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Last Update Date | 08/24/2007
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Provider Practice Location Address
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Address Line | 36 COUNTRY CLUB RD VILLAGE WEST II
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City | GILFORD
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State | NH
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Zip | 03249-6978
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Country | US
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Telephone | 603-524-2050
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Fax | 603-524-2078
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Provider Business Mailing Address
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Address Line | PO BOX 7605
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City | LACONIA
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State | NH
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Zip | 03247-7605
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Country | US
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Telephone | 603-524-2050
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Fax | 603-524-2078
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Authorized Official
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Title or Position | CEO
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Name | MR. CLAYTON RICHARD IRVING
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Credential | DISPENSING OPTICIAN
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Telephone | 603-524-2050
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 156FX1800X
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Taxonomy Name | Optician
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License Number |
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License Number State |
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