Organization Active NPI

Lighthouse Ophthalmology, PLLC

  • Ophthalmology Physician
  • Marquette, MI
National Provider Identifier
1063007128
Registry record updated Mar 1, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Ophthalmology PhysicianTaxonomy code 207W00000X
Legal business name
LIGHTHOUSE OPHTHALMOLOGY, PLLC
Practice address
1414 W Fair Ave Ste 347
Marquette, MI 49855-5407
Phone
(906) 205-2125
NPI assigned
Mar 1, 2021
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 1, 2021

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Dr. Nelson Winkler, MDNPI 1740669944
Title
Physician
Phone
(906) 869-9483

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Ophthalmology PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 207W00000X Primary

Addresses

Primary practice location

1414 W Fair Ave Ste 347
Marquette, MI 49855-5407

Mailing address

65 Elder Dr
Marquette, MI 49855-1667
Phone (906) 869-9483

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MI

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20210412002011 MI Part B Supplier - Clinic/Group Practice 9234547241 Receives reassigned benefits from 2 practitioners
Practice locations: Marquette, MI

National Provider Directory

National Provider Directory

Locations

1414 W Fair Ave
Ste 235
Marquette, MI 49855
Phone 9062732223103

Practitioners & affiliated clinicians

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1614556800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1614556800000",
    "number": "1063007128",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "65 ELDER DR",
            "city": "MARQUETTE",
            "state": "MI",
            "postal_code": "498551667",
            "telephone_number": "906-869-9483"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1414 W FAIR AVE STE 347",
            "city": "MARQUETTE",
            "state": "MI",
            "postal_code": "498555407",
            "telephone_number": "906-205-2125"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LIGHTHOUSE OPHTHALMOLOGY, PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-03-01",
        "last_updated": "2021-03-01",
        "certification_date": "2021-03-01",
        "status": "A",
        "authorized_official_last_name": "WINKLER",
        "authorized_official_first_name": "NELSON",
        "authorized_official_title_or_position": "PHYSICIAN",
        "authorized_official_telephone_number": "906-869-9483",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207W00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Ophthalmology",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Marquette, MI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 1, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.