Great Lakes Independent Eyecare Network LLC

Primary specialty

Exclusive Provider OrganizationTaxonomy code 302F00000X

Legal business name

GREAT LAKES INDEPENDENT EYECARE NETWORK LLC

Practice address

W4790 Ski View Rd
Vulcan, MI 49892-8720

Phone

(877) 488-8900

Fax

(844) 810-8643

NPI assigned

Aug 20, 2012

Organization subpart

No

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

Authorized official

Name

Heidi L Johnson, ODNPI 1578557443

Title

President

Phone

(906) 228-4401

Specialties & licenses 1

Addresses

Practitioners 1

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

• Heidi L Johnson, O.D.,

  • Optometrist
  • Marquette, MI
  • NPI 1578557443
  NPD Authorized official

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

{
    "created_epoch": "1345420800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1712707200000",
    "number": "1235487406",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2425 LUDINGTON ST",
            "address_2": "PMB 175",
            "city": "ESCANABA",
            "state": "MI",
            "postal_code": "498291328",
            "telephone_number": "906-466-9070",
            "fax_number": "906-466-9071"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "W4790 SKI VIEW RD",
            "city": "VULCAN",
            "state": "MI",
            "postal_code": "498928720",
            "telephone_number": "877-488-8900",
            "fax_number": "844-810-8643"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GREAT LAKES INDEPENDENT EYECARE NETWORK LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-08-20",
        "last_updated": "2024-04-10",
        "certification_date": "2024-04-10",
        "status": "A",
        "authorized_official_last_name": "JOHNSON",
        "authorized_official_first_name": "HEIDI",
        "authorized_official_middle_name": "L",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "906-228-4401",
        "authorized_official_credential": "OD"
    },
    "taxonomies": [
        {
            "code": "302F00000X",
            "taxonomy_group": "",
            "desc": "Exclusive Provider Organization",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Robert Bogaudo, PHARM D
• Cheryl Lynn Carlson, P.T.
• Carolyn Faith Clay-Pineda, P.T.
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• Joshua David Schaefer, LMT

• Exclusive Provider Organization in Vulcan, MI
• Providers in Vulcan, MI by specialty
• Exclusive Provider Organization in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 10, 2024; 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.