LOST LAKE OPTICAL COMPANY (NPI# 1003434622) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1003434622 |
| Entity Type | Organization |
| Organization Name | LOST LAKE OPTICAL COMPANY |
| Practice Address |
5240 Shady Island Cir Mound MN 55364-9222 |
| Practice Telephone | 6126708887 |
| Practice Fax Number | 9524741933 |
| Mailing Telephone | 6126708887 |
| Mailing Fax Number | 9524741933 |
| Enumeration Date | 2020-07-09 |
| Last Update Date | 2020-09-04 |
| Authorized Official Name | DR. JAY B. PETERSEN (OWNER) |
| Authorized Official Telephone | 6126708887 |
| Authorized Official Credential | O.D. |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 261Q00000X | Clinic/Center | Ambulatory Health Care Facilities |
| Street Address |
5240 SHADY ISLAND CIR |
| City | MOUND |
| State | MN |
| Zip Code | 55364-9222 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1962992594 | Mary Kaye Guenther | Physical Therapy Assistant | 6670 Game Farm Rd, Mound, MN 55364 | 2018-05-18 |
| 1558893008 | Kirsten Eaton | Student in an Organized Health Care Education/Training Program | 945 Forest Arms Lanes, Mound, MN 55364 | 2017-04-03 |
| 1619322450 | Heidi Durant | Counselor | 2973 Hazelwood Lane, Mound, MN 55364 | 2016-04-29 |
| 1255720603 | Amanda S Myers | Speech-Language Pathologist | 940 Bayside Ln, Minnetrista, MN 55364 | 2015-01-22 |
| 1538447644 | Mary Bernadette Philp | Dentist | 5205 Shoreline Drive, Mound, MN 55364 | 2011-07-25 |
| 1659600088 | Thomas David Mazer | Anesthesiology | 560 North Arm Drive, Orono, MN 55364 | 2009-12-14 |
| 1205913282 | Robert A Lauer | Dentist | 5585 Shoreline Blvd, Mound, MN 55364 | 2006-11-01 |
| 1750470068 | Stephanie Lynn Miner | Dentist | West Lakes Dentistry, 5205 Shoreline Drive, Mound, MN 55364 | 2006-10-12 |
| 1194120519 | Stable Living LLC | Counselor | 6344 Rambler Ln, Mound, MN 55364-1043 | 2014-10-28 |
| 1386800977 | Debra Karen Kullberg | Marriage & Family Therapist | 1567 Bluebird Ln, Mound, MN 55364-1109 | 2008-08-02 |
| Find all providers in zip 55364 | ||||
| Taxonomy Code | 261Q00000X |
| Grouping | Ambulatory Health Care Facilities |
| Classification | Clinic/Center |
| A facility or distinct part of one used for the diagnosis and treatment of outpatients. "Clinic/Center" is irregularly defined, sometimes being limited to organizations serving specialized treatment requirements or distinct patient/client groups (e.g., radiology, poor, and public health). |
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| 1992320014 | Jtp Professional Service Corporation | Clinic/Center | 2038 Ford Pkwy # 444, Saint Paul, MN 55116-1931 | 2020-06-15 |
| 1689299125 | Altru Health System | Clinic/Center | 1st & Roosevelt, Karlstad, MN 56732 | 2020-06-10 |
| 1831710409 | Webmed LLC | Clinic/Center | 925 E Superior St Ste 113, Duluth, MN 55802-2253 | 2020-05-05 |
| 1073149779 | Functional Chiropractic Rehab, Pllc | Clinic/Center | 1901 Madison Ave Ste 120, Mankato, MN 56001-6267 | 2020-03-14 |
| 1225676067 | Liana Healthcare P.ll.c | Clinic/Center | 8348 Beard Rd, Bloomington, MN 55431-1028 | 2019-12-11 |
| 1245875293 | Fairview Clinics | Clinic/Center | 12912 Farnham Ave N, White Bear Lake, MN 55110-5929 | 2019-11-14 |
| 1275175242 | Hye-kyong Kim Therapy LLC | Clinic/Center | 1145 Grand Ave # 101, Saint Paul, MN 55105-2629 | 2019-10-11 |
| 1134773419 | Fairview Clinics | Clinic/Center | 322 E. Broadway Suite E322, Bloomington, MN 55425 | 2019-07-25 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.