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NPI Code Detail

MEDICARE: LAKES REGION OPTICIANS INC

MEDICARE: LAKES REGION OPTICIANS INC
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
1156FX1800XOptician

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1831235472
Entity Type Code : Organization
Provider Name (Legal Business Name) : LAKES REGION OPTICIANS INC
Provider Business Mailing Address
First Line : 3073 WHITE MOUNTAIN HWY
Second Line : MEMORIAL HOSPITAL BOX 5001
City : NORTH CONWAY
State : NH
Zip : 03860-5111
Country : US
Telephone Number : 603-356-4493
Fax Number : 603-356-4493
Provider Business Practice Location Address
First Line : 3073 WHITE MOUNTAIN HWY
Second Line : MEMORIAL HOSPITAL BOX 5001
City : NORTH CONWAY
State : NH
Zip : 03860-5111
Country : US
Telephone Number : 603-356-4493
Fax Number : 603-356-4493
Authorized Official
Title or Position : CEO
Name : MR. CLAYTON RICHARD IRVING
Credential : DISPENSING OPTICIAN
Telephone Number : 603-524-2050
Provider Enumeration Date : 01/30/2007
Last Update Date : 08/24/2007

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1538157292 — MR. DAVID KENT ESMAY CRNA
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1164413399 — DOUGLAS C. TAYLOR M.D.
Practice Location Address:
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Directions to “LAKES REGION OPTICIANS INC ” Practice Location

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