GREAT LAKES EYE CONSULTANTS PLC (NPI# 1164552972) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1164552972 |
| Entity Type | Organization |
| Organization Name | GREAT LAKES EYE CONSULTANTS PLC |
| Practice Address |
872 Munson Ave Suite B Traverse City MI 49686 |
| Mailing Address |
Po Box 308 Acme MI 49610-0308 |
| Practice Telephone | 2319471690 |
| Practice Fax Number | 2319471692 |
| Mailing Telephone | 2319471690 |
| Mailing Fax Number | 2319471692 |
| Enumeration Date | 2007-03-07 |
| Last Update Date | 2018-05-22 |
| Authorized Official Name | DR. PETER FEDOR (OWNER) |
| Authorized Official Telephone | 2319471690 |
| Authorized Official Credential | M.D. |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 207W00000X | Ophthalmology | 4301061885 | MI | Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| MI | 104609651 | 05 | |
| MI | 104609633 | 05 | |
| MI | 104609660 | 05 | |
| MI | 104609642 | 05 |
| Street Address |
872 MUNSON AVE SUITE B |
| City | TRAVERSE CITY |
| State | MI |
| Zip Code | 49686 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1821087560 | Peter D Fedor | Ophthalmology | 872 Munson Ave, Suite B, Traverse City, MI 49686-3638 | 2005-10-16 |
| 1588906119 | Adaptive Counseling and Case Management, LLC | Clinic/Center | 872 Munson Ave, Ste D, Traverse City, MI 49686-3638 | 2013-03-21 |
| 1326339755 | Kevin Mark Debruyn | Social Worker | 872 Munson Ave, Suite D, Traverse City, MI 49686-3638 | 2011-04-19 |
| 1417135922 | Mary Terese Meernik | Optometrist | 872 Munson Ave, Suite B, Traverse City, MI 49686-3638 | 2008-02-06 |
| 1821274150 | Marissa Walkerdine Rogers Do PC | Family Medicine | 872 Munson Ave, Suite D, Traverse City, MI 49686-3638 | 2008-01-16 |
| 1699957571 | Brookside Family Medicine A Center for Health and Well-being Plc | Family Medicine | 872 Munson Ave, Ste D, Traverse City, MI 49686-3638 | 2007-12-03 |
| 1255418158 | Paul L Kropf | Optometrist | 872 Munson Ave, Suite A, Traverse City, MI 49686-3638 | 2006-11-01 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1245877208 | Jessica Marie Glowacki | Behavior Technician | 935 Hemlock St, Traverse City, MI 49686 | 2019-12-09 |
| 1568011542 | Joanne Kressley | Technician | 1693 Maylane Apt. 104, Traverse City, MI 49686 | 2019-09-11 |
| 1194283846 | Pace North | PACE Provider Organization | 2325 Garfield Road N., Traverse City, MI 49686 | 2019-03-12 |
| 1245749225 | Margaret Anne Goss | Speech-Language Pathologist | 1105 E. Eighth Street, Traverse City, MI 49686 | 2017-09-22 |
| 1467981811 | Joan Joyce Shirilla | Social Worker | 2124 Twin Eagles Dr, Traverse City, MI 49686 | 2017-06-08 |
| 1770028763 | Rehab and Mobility Systems, LLC | Durable Medical Equipment & Medical Supplies | 707 Parsons, Traverse City, MI 49686 | 2016-12-29 |
| 1629511316 | Kaitlyn Grangood | Social Worker | 415 Munson Avenue, Ste 101, Traverse City, MI 49686 | 2016-11-29 |
| 1811441132 | Jeffrey D Goodwin | Counselor | 430 Fair St., Traverse City, MI 49686 | 2016-08-04 |
| 1053779918 | Thomas Osborne | Counselor | 2014 Phelps Rd., Traverse City, MI 49686 | 2016-02-08 |
| 1982079588 | Marsha Lynne Dallas | Counselor | 2240 South Airport Road, Traverse City, MI 49686 | 2015-12-08 |
| Find all providers in zip 49686 | ||||
| Taxonomy Code | 207W00000X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Ophthalmology |
| An ophthalmologist has the knowledge and professional skills needed to provide comprehensive eye and vision care. Ophthalmologists are medically trained to diagnose, monitor and medically or surgically treat all ocular and visual disorders. This includes problems affecting the eye and its component structures, the eyelids, the orbit and the visual pathways. In so doing, an ophthalmologist prescribes vision services, including glasses and contact lenses. |
| Notes: Source: American Board of Medical Specialties, 2007. www.abms.org [7/1/2007: definiton added, source added; 7/1/2011: modified source] - Additional Resources: American Board of Ophthalmology, 2007. http://www.abop.org/. American Osteopathic Board of Ophthalmology and Otolaryngology, 2007. http://www.osteopathic.org/certification - Board certification for Medical Doctors (MDs) is provided by the American Board of Ophthalmology. Board certification for Doctors of Osteopathy (DOs) is provided by the American Osteopathic Board of Ophthalmology and Otolaryngology. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1568759314 | William Phillip Potthoff Jr. | Ophthalmology | 601 S Garfield Ave Ste A, Traverse City, MI 49686-3481 | 2011-06-30 |
| 1093877375 | Kenneth B Gum | Ophthalmology | 5199 N Royal Dr, Traverse City, MI 49684-9201 | 2006-12-14 |
| 1952463143 | Amy S Ranger | Ophthalmology | 4033 Eastern Sky Dr, Traverse City, MI 49684-7349 | 2006-12-14 |
| 1801998182 | Northern Vision Eye Care, PC | Ophthalmology | 4033 Easter Sky Drive, Traverse City, MI 49684 | 2006-09-05 |
| 1699750356 | Martin Samuel Arkin | Ophthalmology | 10161 E Pickwick Ct, Suite C, Traverse City, MI 49684-5239 | 2005-12-14 |
| 1821087560 | Peter D Fedor | Ophthalmology | 872 Munson Ave, Suite B, Traverse City, MI 49686-3638 | 2005-10-16 |
| 1770577637 | The Surgery Center | Ophthalmology | 5080 N Royal Dr, Traverse City, MI 49684-9230 | 2005-09-07 |
| 1598759821 | Kenneth H Musson | Ophthalmology | 929 Business Park Dr, Traverse City, MI 49686-8683 | 2005-09-01 |
| 1851383129 | Bradley S Hochstetler | Ophthalmology | 3830 W Front St, Traverse City, MI 49684-8153 | 2005-08-22 |
| 1780686485 | Kean T Oh | Ophthalmology | 860 East Front Street, Traverse City, MI 49686-2704 | 2005-08-12 |
| Find all providers in TRAVERSE CITY | ||||
| City | TRAVERSE CITY |
| Zip Code | 49686 |
Please comment or provide details below to improve the information on GREAT LAKES EYE CONSULTANTS PLC.
| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.