Provider Demographics
NPI:1508402033
Name:VON HOLDT EYE CARE PLLC
Entity Type:Organization
Organization Name:VON HOLDT EYE CARE PLLC
Other - Org Name:LAKE REGION EYE CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:GWEN
Authorized Official - Middle Name:K
Authorized Official - Last Name:THOENNES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:320-763-7055
Mailing Address - Street 1:610 30TH AVE W STE 200
Mailing Address - Street 2:
Mailing Address - City:ALEXANDRIA
Mailing Address - State:MN
Mailing Address - Zip Code:56308-3426
Mailing Address - Country:US
Mailing Address - Phone:320-763-7055
Mailing Address - Fax:320-763-2572
Practice Address - Street 1:610 30TH AVE W STE 200
Practice Address - Street 2:
Practice Address - City:ALEXANDRIA
Practice Address - State:MN
Practice Address - Zip Code:56308-3426
Practice Address - Country:US
Practice Address - Phone:320-763-7055
Practice Address - Fax:320-763-2572
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-11-19
Last Update Date:2019-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty