Provider Demographics
NPI:1386626794
Name:LAMOTTE, ALBERT RAY (OD)
Entity type:Individual
Prefix:DR
First Name:ALBERT
Middle Name:RAY
Last Name:LAMOTTE
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:5009 EVEREST LN N
Mailing Address - Street 2:
Mailing Address - City:PLYMOUTH
Mailing Address - State:MN
Mailing Address - Zip Code:55446-4520
Mailing Address - Country:US
Mailing Address - Phone:612-701-7064
Mailing Address - Fax:952-400-4207
Practice Address - Street 1:12 BRIDGE SQ STE 101
Practice Address - Street 2:
Practice Address - City:ANOKA
Practice Address - State:MN
Practice Address - Zip Code:55303-2463
Practice Address - Country:US
Practice Address - Phone:763-427-4000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-11-20
Last Update Date:2024-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN1893152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN111460000Medicaid
MNC04901OtherMEDICARE PTAN
MNU21651Medicare UPIN