MEDICARE: LAKE VISION PLLC

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

General Provider Information

NPI Number	:	1285565069
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LAKE VISION PLLC

Provider Business Mailing Address
First Line	:	2510 MAPLE GROVE RD STE 500
Second Line	:
City	:	DULUTH
State	:	MN
Zip	:	55811-1829
Country	:	US
Telephone Number	:	218-722-2712
Fax Number	:	218-722-1011

Provider Business Practice Location Address
First Line	:	2510 MAPLE GROVE RD STE 500
Second Line	:
City	:	DULUTH
State	:	MN
Zip	:	55811-1829
Country	:	US
Telephone Number	:	218-722-2712
Fax Number	:	218-722-1011

Authorized Official
Title or Position	:	OPTOMETRIST/OWNER
Name	:	AMY WALKOWIAK
Credential	:	OD
Telephone Number	:	715-817-4393

Provider Enumeration Date	:	05/28/2026
Last Update Date	:	05/28/2026

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Directions to “LAKE VISION PLLC ” Practice Location

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