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Lake Avenue Eyecare LLC — NPI 1396932430, Gothenburg, NE | NPI Central

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NPI 1396932430

OrganizationActive

Lake Avenue Eyecare LLC

NPI 1396932430 · Eyewear Supplier · Gothenburg, NE

Provider details

NPI number: 1396932430
Entity type: Organization
Primary specialty: Eyewear SupplierSuppliers
Organization subpart: No
Authorized official: John Gosnell, Owner(308) 537-3390
License: 1166 (NE)

Specialties & taxonomies

Eyewear SupplierPrimary332H00000XLicense 1166 (NE)
Suppliers
Optometrist152W00000XLicense 1166 (NE)
Eye and Vision Services Providers

Practice location

829 Lake Ave

Gothenburg, NE 69138-1943

Phone: (308) 537-3390

Fax: (308) 537-3391

Approximate (ZIP-level) locationGet directions

More NE providers

Mailing address

829 Lake Ave

Gothenburg, NE 69138-1943

Registry dates

Enumerated: 2007-10-03
Last updated: 2022-10-27
Certified: 2022-10-27

Source: CMS NPPES Data Dissemination (June 2026). NPI Central is not affiliated with CMS. Data is provided as-is from the public registry.