Provider Demographics
NPI:1548957541
Name:LAKEY, ANTONY WILLIAM (BCO)
Entity type:Individual
Prefix:
First Name:ANTONY
Middle Name:WILLIAM
Last Name:LAKEY
Suffix:
Gender:M
Credentials:BCO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1880 LIVINGSTON AVE STE 103
Mailing Address - Street 2:
Mailing Address - City:WEST ST PAUL
Mailing Address - State:MN
Mailing Address - Zip Code:55118-3426
Mailing Address - Country:US
Mailing Address - Phone:651-340-5594
Mailing Address - Fax:844-632-8258
Practice Address - Street 1:1880 LIVINGSTON AVE STE 103
Practice Address - Street 2:
Practice Address - City:WEST ST PAUL
Practice Address - State:MN
Practice Address - Zip Code:55118-3426
Practice Address - Country:US
Practice Address - Phone:651-340-5594
Practice Address - Fax:844-632-8258
Is Sole Proprietor?:No
Enumeration Date:2023-04-19
Last Update Date:2023-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1700XEye and Vision Services ProvidersTechnician/TechnologistOcularist