St Clair Shores Mi Ophthalmology ASC LLC
Organization Active NPI Ambulatory Surgical Clinic/Center · Saint Clair Shores, MI
NPI 1326215468 · NPPES record last updated Sep 21, 2022
Key facts
- NPI
- 1326215468
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Ambulatory Surgical Clinic/Center 261QA1903X
- License
- 506812 (MI)
- Legal business name
- ST CLAIR SHORES MI OPHTHALMOLOGY ASC LLC
- Practice address
- 21711 Greater Mack Ave
Saint Clair Shores, MI 48080-2418 - Phone
- (586) 774-0393
- Fax
- (586) 777-2214
- NPI assigned
- May 8, 2008
- Organization subpart
- No
Authorized official
- Name
- Mr. Jeffrey Snodgrass
- Title
- President
- Phone
- (615) 665-1283
Practitioners 6
-
Mark E Bernthal, OD
-
James W Klein, MD
-
Daniel Malach, M.D.
Medicare Care Compare: Ambulatory surgical center
- Listed as
- Lakeshore Eye Surgery Center
- Medicare certification status
- Active
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in MI
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20080731000269 | MI | Part B Supplier - Ambulatory Surgical Center | 7618041260 | Practice locations: Saint Clair Shores, MI |
National Provider Directory
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Ambulatory Surgical Clinic/Center | 261QA1903X | 506812 | MI | Yes |
Addresses
Primary practice location
21711 Greater Mack Ave
Saint Clair Shores, MI 48080-2418
Mailing address
21711 Greater Mack Ave
Saint Clair Shores, MI 48080-2418
Phone (586) 774-0393
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All providers in Saint Clair Shores, MI · Ambulatory Surgical Clinic/Center in Michigan
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Sep 21, 2022. 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.
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.