GREAT LAKES EYE CARE P.C. NPI 1114058369

NPI Information

  • NPI: 1114058369
  • Provider Name: GREAT LAKES EYE CARE, P.C.
  • Classification: Durable Medical Equipment & Medical Supplies - 332B00000X
  • Entity Type: Organization
  • Doing Business As: GREAT LAKES EYE CARE
  • CLIA Number: 23D2095167
  • Address: 570 BROADWAY ST
    SOUTH HAVEN, MI
    ZIP 49090
  • Phone: (269) 637-3101

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NPI Details

GREAT LAKES EYE CARE, P.C. is a durable medical equipment medical supplies in South Haven, MI. The provider is a supplier of medical equipment such as respirators, wheelchairs, home dialysis systems, or monitoring systems, that are prescribed by a physician for a patient's use in the home and that are usable for an extended period of time. GREAT LAKES EYE CARE, P.C. NPI is 1114058369. The provider is registered as an organization entity type.
The provider Is Doing Business As Great Lakes Eye Care.

The provider's business location address is:

570 BROADWAY ST
SOUTH HAVEN, MI
ZIP 49090-420
Phone: (269) 637-3101
Fax: (269) 637-4000

The provider's authorized official is Brenda S. Jacks .
The authorized official title is Human Resources and has the following contact phone number (269) 428-3300.

The CLIA number assigned to this NPI record is 23D2095167 - physician office with a certificate type of Certificate of Waiver.

The enumeration date for this NPI number is 3/8/2007 and was last updated on 1/26/2023.

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
1332B00000XDurable Medical Equipment & Medical SuppliesMICHIGANYes

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: 11/21/2025

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