Provider Demographics
NPI:1144387077
Name:LANTZ OPTICAL CO
Entity type:Organization
Organization Name:LANTZ OPTICAL CO
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:CASSANDRA
Authorized Official - Middle Name:K
Authorized Official - Last Name:AMUNDSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:320-251-2820
Mailing Address - Street 1:900 WEST ST GERMAIN
Mailing Address - Street 2:
Mailing Address - City:ST CLOUD
Mailing Address - State:MN
Mailing Address - Zip Code:56301
Mailing Address - Country:US
Mailing Address - Phone:320-251-2820
Mailing Address - Fax:
Practice Address - Street 1:900 WEST ST GERMAIN
Practice Address - Street 2:
Practice Address - City:ST CLOUD
Practice Address - State:MN
Practice Address - Zip Code:56301
Practice Address - Country:US
Practice Address - Phone:320-251-2820
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-02
Last Update Date:2008-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332H00000XSuppliersEyewear Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN291NOLAOtherBLUE CROSS BLUE SHIELD OF MINNESOTA
MN291NOLAOtherBLUE CROSS BLUE SHIELD OF MINNESOTA