Great Lakes Eye Care, P.C.

Primary specialty

Durable Medical Equipment & Medical SuppliesTaxonomy code 332B00000X

Legal business name

GREAT LAKES EYE CARE, P.C.

Doing business as

Great Lakes Eye Care

Practice address

570 Broadway St
South Haven, MI 49090-1420

Phone

(269) 637-3101

Fax

(269) 637-4000

NPI assigned

Mar 8, 2007

Last updated

Jan 26, 2023By the provider in NPPES

Organization subpart

Yes

Parent organization

GREAT LAKES EYE CARE, P.C.As reported in NPPES

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

Authorized official

Name

Mrs. Brenda S. Jacks, B.S.

Title

Human Resources

Phone

(269) 428-3300

Specialties & licenses 1

Addresses

Other names 1

• Great Lakes Eye Care Doing business as

Part of

Great Lakes Eye Care

Member organizations 1

Organizations listed as members of this organization in the National Provider Directory.

• Great Lakes Surgery Center LLC

  • Ambulatory Surgical Clinic/Center
  • Saint Joseph, MI
  • NPI 1003273129

  Member Of

  NPD member

Locations

Practitioners 3

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Andrew Manongdo Wang, M.D.

  • Ophthalmology Physician
  • Saint Joseph, MI
  • NPI 1992701098
  NPD
• Nicholas George Keinath, OD

  • Optometrist
  • Saint Joseph, MI
  • NPI 1124886460
  NPD (past)
• Rachel McKuras

  • Optometrist
  • Saint Joseph, MI
  • NPI 1932953205
  NPD (past)

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

{
    "created_epoch": "1173312000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1674691200000",
    "number": "1114058369",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2848 NILES RD",
            "city": "SAINT JOSEPH",
            "state": "MI",
            "postal_code": "490853352",
            "telephone_number": "269-428-3300",
            "fax_number": "269-428-5005"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "570 BROADWAY ST",
            "city": "SOUTH HAVEN",
            "state": "MI",
            "postal_code": "490901420",
            "telephone_number": "269-637-3101",
            "fax_number": "269-637-4000"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GREAT LAKES EYE CARE, P.C.",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "GREAT LAKES EYE CARE, P.C.",
        "enumeration_date": "2007-03-08",
        "last_updated": "2023-01-26",
        "certification_date": "2023-01-26",
        "status": "A",
        "authorized_official_last_name": "JACKS",
        "authorized_official_first_name": "BRENDA",
        "authorized_official_middle_name": "S.",
        "authorized_official_title_or_position": "HUMAN RESOURCES",
        "authorized_official_telephone_number": "269-428-3300",
        "authorized_official_name_prefix": "Mrs.",
        "authorized_official_credential": "B.S."
    },
    "taxonomies": [
        {
            "code": "332B00000X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies",
            "state": "MI",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Great Lakes Eye Care",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Great Lakes Eye Care",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Isabel Garcia
• Evan Ashley Gillo, PA-C
• William Dean Gilmer, CRNA
• Rhonda Jo Gola, FNP
• Graceway South Haven, LLC
• Carly Anastacia Greenhoe, PHARMD
• Josiah Griffore
• Amy Haas, LLPC
• Carolyn Kay Haas, LMSW
• Katherine Elizabeth Hampton, FNP

• Durable Medical Equipment & Medical Supplies in South Haven, MI
• Providers in South Haven, MI by specialty
• Durable Medical Equipment & Medical Supplies in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 26, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.