Provider Demographics
NPI:1851835011
Name:LAKELAND VILLAGE EYE CARE PLLC
Entity Type:Organization
Organization Name:LAKELAND VILLAGE EYE CARE PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OD
Authorized Official - Prefix:
Authorized Official - First Name:MICHELE
Authorized Official - Middle Name:A
Authorized Official - Last Name:QUINTERO
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:832-684-9808
Mailing Address - Street 1:9945 BARKER CYPRESS RD
Mailing Address - Street 2:
Mailing Address - City:CYPRESS
Mailing Address - State:TX
Mailing Address - Zip Code:77433-5317
Mailing Address - Country:US
Mailing Address - Phone:832-684-9808
Mailing Address - Fax:281-254-7788
Practice Address - Street 1:9945 BARKER CYPRESS RD
Practice Address - Street 2:
Practice Address - City:CYPRESS
Practice Address - State:TX
Practice Address - Zip Code:77433-5317
Practice Address - Country:US
Practice Address - Phone:832-684-9808
Practice Address - Fax:281-254-7788
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-12-07
Last Update Date:2016-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty