Provider Demographics
NPI:1609826577
Name:LACH, GEORGE JOHN JR (OD)
Entity Type:Individual
Prefix:DR
First Name:GEORGE
Middle Name:JOHN
Last Name:LACH
Suffix:JR
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1722 CANDI LN
Mailing Address - Street 2:
Mailing Address - City:NORTH MANKATO
Mailing Address - State:MN
Mailing Address - Zip Code:56003-2001
Mailing Address - Country:US
Mailing Address - Phone:507-388-7902
Mailing Address - Fax:
Practice Address - Street 1:220 E MAIN ST
Practice Address - Street 2:
Practice Address - City:MANKATO
Practice Address - State:MN
Practice Address - Zip Code:56001-3574
Practice Address - Country:US
Practice Address - Phone:507-345-5087
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN2758152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN07021Medicare ID - Type Unspecified
U76913Medicare UPIN