Great Lakes Eye Consultants PLC

Primary specialty

Ophthalmology PhysicianTaxonomy code 207W00000X

License

4301061885 Issued in MI

Legal business name

GREAT LAKES EYE CONSULTANTS PLC

Practice address

872 Munson Ave
Suite B
Traverse City, MI 49686

Phone

(231) 947-1690

Fax

(231) 947-1692

NPI assigned

Mar 7, 2007

Last updated

May 22, 2018By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Dr. Peter Fedor, M.D.NPI 1821087560

Title

Owner

Phone

(231) 947-1690

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in MI

Enrollment records 1

Locations

Practitioners 8

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.

• Peter D Fedor, MD

  • Ophthalmology Physician
  • Traverse City, MI
  • NPI 1821087560
  Medicare reassignment NPD Authorized official
• Robert A Aubry, OD

  • Optometrist
  • Grayling, MI
  • NPI 1851477947
  NPD (past)
• William I Dean, OD

  • Optometrist
  • Grayling, MI
  • NPI 1861578957
  NPD (past)
• Julie Theriault Timperley, OD

  • Optometrist
  • Gaylord, MI
  • NPI 1295876357
  NPD (past)
• Joseph T Trubiroha, O.D.

  • Optometrist
  • Cadillac, MI
  • NPI 1689750507
  NPD (past)
• Lindsay Lorin Wade, O.D

  • Optometrist
  • Gaylord, MI
  • NPI 1407296296
  NPD (past)
• Emily N Stouffer, NP-C

  • Nurse Practitioner
  • Chicago, IL
  • NPI 1063728202
  NPD (past)
• Eileen Turgeon, O.T.

  • Occupational Therapist
  • Fort Collins, CO
  • NPI 1881929982
  NPD (past)

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

{
    "created_epoch": "1173225600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1526947200000",
    "number": "1164552972",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 308",
            "city": "ACME",
            "state": "MI",
            "postal_code": "496100308",
            "telephone_number": "231-947-1690",
            "fax_number": "231-947-1692"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "872 MUNSON AVE",
            "address_2": "SUITE B",
            "city": "TRAVERSE CITY",
            "state": "MI",
            "postal_code": "49686",
            "telephone_number": "231-947-1690",
            "fax_number": "231-947-1692"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GREAT LAKES EYE CONSULTANTS PLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-03-07",
        "last_updated": "2018-05-22",
        "status": "A",
        "authorized_official_last_name": "FEDOR",
        "authorized_official_first_name": "PETER",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "231-947-1690",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "207W00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Ophthalmology",
            "state": "MI",
            "license": "4301061885",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Natalie A Gray, MD
• Tracey Lynn Gray, M.A., CCC-SLP
• Great Lakes Cardiology, P.C.
• Great Lakes Chiropractic of Michigan PLLC
• Great Lakes Dental Group
• Great Lakes Foot & Ankle Specialist, PLLC
• Great Lakes Foot and Ankle Specialists
• Great Lakes Home Healthcare Specialists, LLC
• Great Lakes Integrated Health PLLC (Great Lakes Integrated Health)
• Great Lakes Online Counseling LLC

• Ophthalmology Physician in Traverse City, MI
• Providers in Traverse City, MI by specialty
• Ophthalmology Physician in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 22, 2018; 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.