GREAT LAKES EYE INSTITUTE NPI 1427090976

NPI Information

NPI: 1427090976
Provider Name: GREAT LAKES EYE INSTITUTE
Classification: Ophthalmology - 207WX0107X
Entity Type: Organization

Specialization: Retina Specialist

CLIA Number: 23D1059394

Address:
2393 SCHUST RD
SAGINAW, MI
ZIP 48603
Phone: (989) 793-2820
Get Directions

GREAT LAKES EYE INSTITUTE is a retina specialist ophthalmology in Saginaw, MI. The provider is an ophthalmologist who specializes in the diagnosis and treatment of vitreoretinal diseases. GREAT LAKES EYE INSTITUTE NPI is 1427090976. The provider is registered as an organization entity type and is a multi-specialty group.

The provider's business location address is:

2393 SCHUST RD
SAGINAW, MI
ZIP 48603-334
Phone: (989) 793-2820
Fax: (989) 793-9132

The provider's authorized official is Farhad Kayvan Shokoohi .
The authorized official title is Owner and has the following contact phone number (989) 793-2820.

The CLIA number assigned to this NPI record is 23D1059394 - ambulatory surgery center with a certificate type of Certificate of Waiver.

The enumeration date for this NPI number is 6/11/2006 and was last updated on 1/19/2018.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.	Taxonomy Code	Taxonomy Clasification	Taxonomy Specialization	License Number	License State	Primary
1	207W00000X	Ophthalmology		43010040619	MICHIGAN	No
2	207WX0107X	Ophthalmology	Retina Specialist	4301102705	MICHIGAN	Yes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No.	Other Provider Identifier	Other Provider Identifier Type	Other Provider Identifier State	Other Provider Identifier Issuer
1	CA3610	OTHER	MICHIGAN	RR MEDICARE
2	0G36036	OTHER		MEDICARE
3	180G300890	OTHER	MICHIGAN	BLUE CARE NETWORK
4	180G300890	OTHER	MICHIGAN	FEDERAL EMPLOYEES PROGRAM BLUE CROSS
5	180G300890	OTHER	MICHIGAN	BLUE CROSS BLUE SHIELD

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 11/14/2023

NPI Synchronization or Removal

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