Great Lakes Eye Consultants PLC
Organization Active NPI Ophthalmology Physician · Traverse City, MI
NPI 1164552972 · NPPES record last updated May 22, 2018
Key facts
- NPI
- 1164552972
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Ophthalmology Physician 207W00000X
- License
- 4301061885 (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
- Organization subpart
- No
Authorized official
- Name
- Dr. Peter Fedor, M.D.
- Title
- Owner
- Phone
- (231) 947-1690
Practitioners 8
-
Peter D Fedor, MD
-
Robert A Aubry, OD
-
William I Dean, OD
-
Joseph T Trubiroha, O.D.
-
Lindsay Lorin Wade, O.D
-
Emily N Stouffer, NP-C
-
Eileen Turgeon, O.T.
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in MI
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20040824000859 | MI | Part B Supplier - Clinic/Group Practice | 6507830684 |
Receives reassigned benefits from 1 practitioner Practice locations: Cadillac, MI; Gaylord, MI; Traverse City, MI |
National Provider Directory
Locations
234 E Michigan Ave
Ste 1
Grayling, MI 49738
Phone (989) 350-6500
872 Munson Ave
Ste B
Traverse City, MI 49686
Phone (231) 922-0400
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Ophthalmology Physician |
207W00000X | 4301061885 | MI | Yes |
Addresses
Primary practice location
872 Munson Ave
Suite B
Traverse City, MI 49686
Mailing address
PO Box 308
Acme, MI 49610-0308
Phone (231) 947-1690
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 104609642 | Medicaid | MI | |
| 104609651 | Medicaid | MI | |
| 104609660 | Medicaid | MI | |
| 104609633 | Medicaid | MI |
Other providers in Traverse City, MI
- Natalie A Gray
- Tracey Lynn Gray
- 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 Online Counseling LLC
All providers in Traverse City, MI · Ophthalmology Physician in Michigan
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on May 22, 2018. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.