LAKESIDE VISION, PRUDENVILLE, PC
NPI 1003557133
Optometrist in Prudenville, MI
About Lakeside Vision, Prudenville, Pc NPPES
Official registry information on file with the National Plan and Provider Enumeration System.
LAKESIDE VISION, PRUDENVILLE, PC (NPI 1003557133) is a healthcare organization registered as an optometrist in Prudenville, Michigan and active in the NPI registry since April 2022. The organization lists Kyle Bates, Optometrist, as its authorized official.
NPPES Registry Identity
Specialties & Licenses
Group Practice 1
Accepted Insurance
Medicare Participation & PECOS CMS
Medicare enrollment and the clinicians who bill Medicare through this organization, from CMS.
Medicare Enrollment Status
Enrolled in Medicare (PECOS)
Lakeside Vision, Prudenville, Pc is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).
Clinicians Billing Medicare Through This Organization
3Medicare enrollment records show 3 clinicians reassign Medicare billing to Lakeside Vision, Prudenville, PC, which bills Medicare for the services they deliver. Of these, 2 practice at this address. They are listed nearest first.
Clinicians, nearest first (3)
Source: CMS Revalidation Reassignment List, October 2026 release. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.
Frequently Asked Questions NPPES & CMS
Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.
What is Lakeside Vision, Prudenville, PC's NPI number?
The NPI number for Lakeside Vision, Prudenville, PC is 1003557133. It was assigned to this organization in the NPPES registry on April 5, 2022.
Where is Lakeside Vision, Prudenville, PC located?
Lakeside Vision, Prudenville, PC is located at 888 W Houghton Lake Dr, Prudenville, MI 48651. The listed phone number is (989) 366-7525.
What is Lakeside Vision, Prudenville, PC's specialty?
The primary specialty registered for this NPI is Optometrist with taxonomy code 152W00000X.
Is Lakeside Vision, Prudenville, PC enrolled in Medicare?
Yes. Lakeside Vision, Prudenville, PC is registered in the Medicare PECOS enrollment system.
How many clinicians bill Medicare through Lakeside Vision, Prudenville, PC?
According to the CMS Revalidation Reassignment List (October 2026 release), 3 clinicians, all in Optometry, reassign their Medicare billing to Lakeside Vision, Prudenville, PC. A reassignment is filed with Medicare on form CMS-855R, signed by both the clinician and the organization, and lets the organization bill Medicare and receive payment for the clinician's services. Of these, 2 practice at this address. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.
What insurance does Lakeside Vision, Prudenville, PC accept?
Health plans from Anthem Blue Cross and Blue Shield, Blue Care Network of Michigan, Blue Cross Blue Shield of Michigan Mutual Insurance Company, Blue Cross and Blue Shield of Montana and Blue Cross and Blue Shield of Oklahoma and 2 other insurers list Lakeside Vision, Prudenville, PC as in-network in at least one marketplace plan. Coverage varies by plan and year; verify with the insurer or the provider before a visit.
When was this NPI record last updated?
The NPPES record for Lakeside Vision, Prudenville, PC was last updated on April 5, 2022. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 4 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.
# Lakeside Vision, Prudenville, Pc · NPI 1003557133
Optometrist organization in Prudenville, Michigan. Organization record, active in the CMS NPPES registry since April 5, 2022.
## Identity
- **NPI:** 1003557133 (Entity type: Organization)
- **Enumerated:** April 5, 2022
- **Primary specialty:** Optometrist · taxonomy 152W00000X
- **Organization subpart:** No
- **Authorized official:** Kyle Bates, OPTOMETRIST
## Practice location
- **Address:** 888 W HOUGHTON LAKE DR, Prudenville, MI 48651-9451
- **Phone:** (989) 366-7525 · **Fax:** (989) 366-5405
## Medicare
- **Medicare:** Enrolled in Medicare (PECOS)
- **Clinicians billing through this organization:** 3 clinicians (Optometry) reassign Medicare billing to this organization (form CMS-855R); 2 practice at this address · CMS Revalidation Reassignment List, October 2026 release
## Record status
- **NPPES last updated:** April 5, 2022
---
Source: [NPI Profile](https://npiprofile.com/npi/1003557133) · Data from the CMS NPPES public registry.