OrganizationActive
Lost Lake Optical Company
NPI 1003434622 · Clinic/Center · Mound, MN
Provider details
- NPI number
- 1003434622
- Entity type
- Organization
- Primary specialty
- Clinic/CenterAmbulatory Health Care Facilities
- Organization subpart
- No
- Authorized official
- Jay Petersen, Owner(612) 670-8887
Specialties & taxonomies
Ambulatory Health Care Facilities
Profile Score
Established profile(64/100 index)
A profile completeness & documented-activity index — NOT a quality, outcomes, or patient-satisfaction rating.
- Registry tenure38% of score
5 yrs in NPPES registry
- Profile completeness38% of score
100% of core fields populated
- Practice footprint23% of score
1 documented practice location
Signals a provider has no public data for (e.g. Medicare claims) are left out of the score entirely — never counted as zero — so providers without that data are not penalized. See the full formula and weights in our methodology.
Practice location
5240 Shady Island Cir
Mound, MN 55364-9222
Phone: (612) 670-8887
Fax: (952) 474-1933
Street-level locationGet directions
Mailing address
5240 Shady Island Cir
Mound, MN 55364-9222
Registry dates
- Enumerated
- 2020-07-09
- Last updated
- 2020-09-04
- Certified
- 2020-09-04
Source: CMS NPPES Data Dissemination (June 2026). NPI Central is not affiliated with CMS. Data is provided as-is from the public registry.