Provider Demographics
NPI:1881984938
Name:LAKES REGION OPTICIANS, INC
Entity type:Organization
Organization Name:LAKES REGION OPTICIANS, INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/DISPENSING OPTICIAN
Authorized Official - Prefix:MR
Authorized Official - First Name:RICH
Authorized Official - Middle Name:M
Authorized Official - Last Name:IRVING
Authorized Official - Suffix:
Authorized Official - Credentials:REG OPTICIAN
Authorized Official - Phone:603-524-2050
Mailing Address - Street 1:390 BAR HARBOR RD
Mailing Address - Street 2:
Mailing Address - City:TRENTON
Mailing Address - State:ME
Mailing Address - Zip Code:04605-5807
Mailing Address - Country:US
Mailing Address - Phone:207-664-2782
Mailing Address - Fax:207-664-2782
Practice Address - Street 1:390 BAR HARBOR RD
Practice Address - Street 2:
Practice Address - City:TRENTON
Practice Address - State:ME
Practice Address - Zip Code:04605-5807
Practice Address - Country:US
Practice Address - Phone:207-664-2782
Practice Address - Fax:207-664-2782
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-04-11
Last Update Date:2011-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH1635156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOpticianGroup - Single Specialty