Lost Lake Optical Company
NPI #1003434622 in Mound, Minnesota
Provider Information
- NPI Number
- 1003434622
- Entity Type
- Organization
- Organization Name
- Lost Lake Optical Company
- Primary Specialty
- Clinic/Center
- Enumeration Date
- Jul 9, 2020
- Last Updated
- Sep 4, 2020
Practice Location
Authorized Official
- Name
- DR. JAY B. PETERSEN, O.D.
- Title
- OWNER
- Phone
- (612) 670-8887
Specialties & Taxonomy Codes
| Specialty |
|---|
| Clinic/Center |
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