| Lakeside Vision Inc | |
|
888 W Houghton Lake Dr, Prudenville, MI 48651-9451 | |
| (989) 366-7525 | |
| (989) 366-5405 |
| Full Name | Lakeside Vision Inc |
|---|---|
| Type | Facility |
| Speciality | Optometrist |
| Location | 888 W Houghton Lake Dr, Prudenville, Michigan |
| Accepts Medicare Assignments | Medicare enrolled and accepts medicare insurance. Providers at this facility may prescribe medicare part D drugs. |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1790789550 | NPI | - | NPPES |
| 1562533 | Medicaid | MI | |
| 900G21001 | Other | MI | BLUE CROSS BLUE SHIELD |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 152W00000X | Optometrist | MI2953 (Michigan) | Primary |
| Provider Name | Louis E Boggs |
|---|---|
| Provider Type | Practitioner - Optometry |
| Provider Identifiers | NPI Number: 1134123987 PECOS PAC ID: 6709950157 Enrollment ID: I20080801000395 |
| Provider Name | Kyle Scott Bates |
|---|---|
| Provider Type | Practitioner - Optometry |
| Provider Identifiers | NPI Number: 1932767191 PECOS PAC ID: 0648504241 Enrollment ID: I20190702002146 |
| Mailing Address | Practice Location Address |
|---|---|
| Lakeside Vision Inc 888 W Houghton Lake Dr, P O Box 20, Prudenville, MI 48651-9451 Ph: (989) 366-7525 | Lakeside Vision Inc 888 W Houghton Lake Dr, Prudenville, MI 48651-9451 Ph: (989) 366-7525 |
Lakeside Vision, Prudenville, Pc Optometrist Medicare: Medicare Enrolled Practice Location: 888 W Houghton Lake Dr, Prudenville, MI 48651 Phone: 989-366-7525 Fax: 989-366-5405 | |
Louis E Boggs, O.D. Optometrist Medicare: Accepting Medicare Assignments Practice Location: 888 W Houghton Lake Dr, Prudenville, MI 48651 Phone: 989-366-7525 Fax: 989-366-5405 | |
Dr. Kyle Scott Bates, OD Optometrist Medicare: Accepting Medicare Assignments Practice Location: 888 W Houghton Lake Dr, Prudenville, MI 48651 Phone: 989-366-7525 |