MEDICARE: DR. GEORGE JOHN LACH JR. O.D.

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	2758	MN

General Provider Information

NPI Number	:	1609826577
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. GEORGE JOHN LACH JR. O.D.

Provider Business Mailing Address
First Line	:	1722 CANDI LN
Second Line	:
City	:	NORTH MANKATO
State	:	MN
Zip	:	56003-2001
Country	:	US
Telephone Number	:	507-388-7902
Fax Number	:

Provider Business Practice Location Address
First Line	:	220 E MAIN ST
Second Line	:
City	:	MANKATO
State	:	MN
Zip	:	56001-3574
Country	:	US
Telephone Number	:	507-345-5087
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/11/2006
Last Update Date	:	07/08/2007

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