GREAT LAKES EYE INSTITUTE (NPI# 1427090976) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1427090976 |
| Entity Type | Organization |
| Organization Name | GREAT LAKES EYE INSTITUTE |
| Practice Address |
2393 Schust Rd Saginaw MI 48603-1334 |
| Practice Telephone | 9897932820 |
| Practice Fax Number | 9897939132 |
| Mailing Telephone | 9897932820 |
| Mailing Fax Number | 9897939132 |
| Enumeration Date | 2006-06-11 |
| Last Update Date | 2018-01-19 |
| Authorized Official Name | FARHAD KAYVAN SHOKOOHI (OWNER) |
| Authorized Official Telephone | 9897932820 |
| Authorized Official Credential | M.D. |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 207W00000X | Ophthalmology | 43010040619 | MI | Allopathic & Osteopathic Physicians |
| Y | 207WX0107X |
Ophthalmology Specialization: Retina Specialist |
4301102705 | MI | Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| MI | BLUE CARE NETWORK | 180G300890 | 01 |
| MEDICARE | 0G36036 | 01 | |
| MI | BLUE CROSS BLUE SHIELD | 180G300890 | 01 |
| MI | FEDERAL EMPLOYEES PROGRAM BLUE CROSS | 180G300890 | 01 |
| MI | RR MEDICARE | CA3610 | 01 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1003437823 | Great Lakes Eye Institute | Ophthalmology | 800 Woodside Ave, Bay City, MI 48708-5468 | 2020-05-04 |
| 1447434378 | Great Lakes Eye Institute | Optometrist | 4624 Hill St, Cass City, MI 48726-1119 | 2007-12-27 |
| 1841474772 | Great Lakes Eye Institute | Optometrist | 406 W Genesee St, Frankenmuth, MI 48734-1311 | 2007-12-27 |
| 1346424272 | Great Lakes Eye Institute | Optometrist | 623 W Warwick Dr, Suite 1, Alma, MI 48801-1177 | 2007-12-27 |
| 1063680791 | Great Lakes Eye Institute | Optometrist | 2393 Schust Rd, Saginaw, MI 48603-1334 | 2008-02-15 |
| 1992985840 | Great Lakes Eye Institute | Optometrist | 2393 Schust Rd, Saginaw, MI 48603-1334 | 2007-11-08 |
| Street Address |
2393 SCHUST RD |
| City | SAGINAW |
| State | MI |
| Zip Code | 48603-1334 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1518961556 | Brian D. Dudenhoefer | Ophthalmology | 2393 Schust Rd, Saginaw, MI 48603-1334 | 2005-06-08 |
| 1295180214 | Nicholas David Shokoohi | Ophthalmology | 2393 Schust Rd, Saginaw, MI 48603-1334 | 2016-04-27 |
| 1528329489 | Victoria Ayn Williams | Ophthalmology | 2393 Schust Rd, Saginaw, MI 48603-1334 | 2012-06-06 |
| 1699939751 | Kristine Marie Weaver | Optometrist | 2393 Schust Rd, Saginaw, MI 48603-1334 | 2008-07-17 |
| 1063680791 | Great Lakes Eye Institute | Optometrist | 2393 Schust Rd, Saginaw, MI 48603-1334 | 2008-02-15 |
| 1073798211 | Great Lakes Eye Surgery Center LLC | Clinic/Center | 2393 Schust Rd, Saginaw, MI 48603-1334 | 2008-01-07 |
| 1992985840 | Great Lakes Eye Institute | Optometrist | 2393 Schust Rd, Saginaw, MI 48603-1334 | 2007-11-08 |
| 1265542849 | Great Lakes Eye Surgery Center LLC | Clinic/Center | 2393 Schust Rd, Saginaw, MI 48603-1334 | 2006-08-30 |
| 1689685463 | Moonyoung S Chung | Ophthalmology | 2393 Schust Rd, Saginaw, MI 48603-1334 | 2006-08-10 |
| 1780602763 | Scott M Vandenbelt | Ophthalmology | 2393 Schust Rd, Saginaw, MI 48603-1334 | 2006-07-17 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1518503952 | Kimberly Michelle Cole | Social Worker | 2823 Pimlico Ln, Saginaw, MI 48603 | 2019-11-20 |
| 1669035895 | Kristine Anna Roberts | Massage Therapist | 3175 Christy Way 8, Saginaw, MI 48603 | 2019-04-14 |
| 1114413069 | Sabrina Shunnarah | Behavioral Analyst | 3267 Schust Road, Apt. 101, Saginaw, MI 48603 | 2018-07-03 |
| 1740708528 | Alexandra Jennette Hengy | Student in an Organized Health Care Education/Training Program | 4287 Harbour Towne Dr Apt. 6, Saginaw, MI 48603 | 2017-08-31 |
| 1003345380 | Karissa Irene Piar | Social Worker | 2100 Hemmeter Rd., Saginaw, MI 48603 | 2017-06-08 |
| 1922537281 | Anita Rick | Behavior Technician | 3949 N. River Road, Freeland, Mi 48623, Freeland, MI 48603 | 2017-06-08 |
| 1417300393 | Saginaw County Community Mental Health Authority | In Home Supportive Care | 3875 Bay Rd., Saginaw, MI 48603 | 2016-07-15 |
| 1992154009 | Tricity Diagnostics, LLC | Physiological Laboratory | 3055 Enterprise Drive, Suite 2, Saginaw, MI 48603 | 2016-06-09 |
| 1659744571 | Janet Lee Smith | Social Worker | 4341 Barnard Rd, Saginaw, MI 48603 | 2015-11-02 |
| 1255656757 | Joseph Edward Chmielewski | Chiropractor | 4266 State St., Saginaw, MI 48603 | 2010-03-29 |
| Find all providers in zip 48603 | ||||
| Taxonomy Code | 207WX0107X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Ophthalmology |
| Specialization | Retina Specialist |
| An ophthalmologist who specializes in the diagnosis and treatment of vitreoretinal diseases. |
| Notes: Source: American Society of Retina Specialists, www.asrs.org [1/1/2017: new] - Additional Resources: American Academy of Ophthalmology, www.aao.org. Macula Society, www.maculasociety.org. Retina Society, www.retinasociety.org. Association of University Professors of Ophthalmology, www.aupo.org. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1639781545 | Harbor Retina Center Pllc | Ophthalmology | 3273 Davison Rd Ste 1, Lapeer, MI 48446-2902 | 2020-08-21 |
| 1902260698 | Drew Scoles | Ophthalmology | 3555 W 13 Mile Rd Ste Ll-20, Royal Oak, MI 48073-6710 | 2016-04-08 |
| 1225007198 | Steven A Boskovich Md PC | Ophthalmology | 1290 S Linden Rd, Flint, MI 48532-3407 | 2006-03-14 |
Please comment or provide details below to improve the information on GREAT LAKES EYE INSTITUTE.
| 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.