Provider Demographics
NPI:1811487150
Name:LATITUDE 61 EYECARE, LLC
Entity type:Organization
Organization Name:LATITUDE 61 EYECARE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPTOMETRIST
Authorized Official - Prefix:DR
Authorized Official - First Name:LORETTA
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:FLAITZ
Authorized Official - Suffix:
Authorized Official - Credentials:OD, MBA, FAAO
Authorized Official - Phone:605-200-0930
Mailing Address - Street 1:7899 STATE ROUTE 21
Mailing Address - Street 2:
Mailing Address - City:HORNELL
Mailing Address - State:NY
Mailing Address - Zip Code:14843-9669
Mailing Address - Country:US
Mailing Address - Phone:605-200-0930
Mailing Address - Fax:
Practice Address - Street 1:5800 WESTOVER AVE
Practice Address - Street 2:
Practice Address - City:JBER
Practice Address - State:AK
Practice Address - Zip Code:99506-1603
Practice Address - Country:US
Practice Address - Phone:907-753-7515
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-05-11
Last Update Date:2018-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty