Provider Demographics
NPI:1811370885
Name:LAKESIDE FAMILY EYECARE, PC
Entity Type:Organization
Organization Name:LAKESIDE FAMILY EYECARE, PC
Other - Org Name:TODAY'S VISION LEAGUE CITY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/OPTOMETRIST
Authorized Official - Prefix:
Authorized Official - First Name:NICOLE
Authorized Official - Middle Name:
Authorized Official - Last Name:ROBBINS
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:832-340-7548
Mailing Address - Street 1:1335 E LEAGUE CITY PKWY
Mailing Address - Street 2:SUITE 200
Mailing Address - City:LEAGUE CITY
Mailing Address - State:TX
Mailing Address - Zip Code:77573-6027
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1335 E LEAGUE CITY PKWY
Practice Address - Street 2:SUITE 200
Practice Address - City:LEAGUE CITY
Practice Address - State:TX
Practice Address - Zip Code:77573-6027
Practice Address - Country:US
Practice Address - Phone:832-781-0520
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-07-08
Last Update Date:2015-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty