Provider Demographics
NPI:1861550741
Name:GUTFLEISCH, LANCE EMIL (OD)
Entity type:Individual
Prefix:DR
First Name:LANCE
Middle Name:EMIL
Last Name:GUTFLEISCH
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 464
Mailing Address - Street 2:
Mailing Address - City:WASECA
Mailing Address - State:MN
Mailing Address - Zip Code:56093-0464
Mailing Address - Country:US
Mailing Address - Phone:952-465-2719
Mailing Address - Fax:
Practice Address - Street 1:2000 NE COURT
Practice Address - Street 2:
Practice Address - City:BLOOMINGTON
Practice Address - State:MN
Practice Address - Zip Code:55425-5506
Practice Address - Country:US
Practice Address - Phone:952-853-1143
Practice Address - Fax:952-853-0591
Is Sole Proprietor?:No
Enumeration Date:2006-12-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN2965152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN22-02832OtherMEDICA
MN84M32GUOtherBCBS
MN222525OtherEYEMED
MNA02161044528OtherPREFERRED ONE