Provider Demographics
NPI:1811191513
Name:L.C. OPTOMETRIC P.C.
Entity Type:Organization
Organization Name:L.C. OPTOMETRIC P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:ANTHONY
Authorized Official - Middle Name:
Authorized Official - Last Name:LOVCIK
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:763-416-1983
Mailing Address - Street 1:12131 ELM CREEK BLVD N
Mailing Address - Street 2:
Mailing Address - City:MAPLE GROVE
Mailing Address - State:MN
Mailing Address - Zip Code:55369-7093
Mailing Address - Country:US
Mailing Address - Phone:763-416-1983
Mailing Address - Fax:763-416-4084
Practice Address - Street 1:12131 ELM CREEK BLVD N
Practice Address - Street 2:
Practice Address - City:MAPLE GROVE
Practice Address - State:MN
Practice Address - Zip Code:55369-7093
Practice Address - Country:US
Practice Address - Phone:763-416-1983
Practice Address - Fax:763-416-4084
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-14
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN2638152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN60P13LOOtherBLUE CROSS GROUP NUMBER
MN96531OtherHEALTH PARTNERS GROUP NUM
MN1204389OtherAETNA
MN96531OtherHEALTH PARTNERS GROUP NUM