MEDICARE: LAKELAND EYE CLINIC PA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	152W00000X	Optometrist
2	207W00000X	Ophthalmology Physician

General Provider Information

NPI Number	:	1154414159
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LAKELAND EYE CLINIC PA

Provider Business Mailing Address
First Line	:	1247 LAKELAND HILLS BLVD
Second Line	:
City	:	LAKELAND
State	:	FL
Zip	:	33805-4673
Country	:	US
Telephone Number	:	863-688-5604
Fax Number	:

Provider Business Practice Location Address
First Line	:	1247 LAKELAND HILLS BLVD
Second Line	:
City	:	LAKELAND
State	:	FL
Zip	:	33805-4673
Country	:	US
Telephone Number	:	863-688-5604
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	KEVIN A DORSETT
Credential	:	MD
Telephone Number	:	863-688-5604

Provider Enumeration Date	:	10/02/2006
Last Update Date	:	09/14/2022

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