Provider Demographics
NPI:1457666729
Name:LAKESIDE VISION, PLLC
Entity type:Organization
Organization Name:LAKESIDE VISION, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPTOMETRIST
Authorized Official - Prefix:DR
Authorized Official - First Name:LAURA
Authorized Official - Middle Name:
Authorized Official - Last Name:FISCHER
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:509-879-8376
Mailing Address - Street 1:22106 E COUNTRY VISTA DR
Mailing Address - Street 2:SUITE A
Mailing Address - City:LIBERTY LAKE
Mailing Address - State:WA
Mailing Address - Zip Code:99019-6017
Mailing Address - Country:US
Mailing Address - Phone:509-927-2020
Mailing Address - Fax:509-927-0101
Practice Address - Street 1:22106 E COUNTRY VISTA DR
Practice Address - Street 2:SUITE A
Practice Address - City:LIBERTY LAKE
Practice Address - State:WA
Practice Address - Zip Code:99019-6017
Practice Address - Country:US
Practice Address - Phone:509-927-2020
Practice Address - Fax:509-927-0101
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-08-11
Last Update Date:2010-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAOD 00003973152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty