St Clair Shores Mi Ophthalmology ASC LLC

Primary specialty

Ambulatory Surgical Clinic/CenterTaxonomy code 261QA1903X

License

506812 Issued in 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

Last updated

Sep 21, 2022By 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

Mr. Jeffrey Snodgrass

Title

President

Phone

(615) 665-1283

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in MI

Enrollment records 1

Listed as

Lakeshore Eye Surgery CenterCCN 23C0001006

Medicare certification status

ActiveFrom the Provider of Services file

Locations

Practitioners 6

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.

• Mark E Bernthal, OD

  • Optometrist
  • Saint Clair Shores, MI
  • NPI 1811991391
  NPD
• Mariann M Channell, MD

  • Ophthalmology Physician
  • Saint Clair Shores, MI
  • NPI 1225030596
  NPD
• James W Klein, MD

  • Ophthalmology Physician
  • Saint Clair Shores, MI
  • NPI 1104828482
  NPD
• Daniel Malach, M.D.

  • Ophthalmology Physician
  • Saint Clair Shores, MI
  • NPI 1487003612
  NPD
• Matthew Allen McKee, MD

  • Ophthalmology Physician
  • Brighton, MI
  • NPI 1326205089
  NPD
• Richard L Watnick, MD

  • Ophthalmology Physician
  • Roseville, MI
  • NPI 1144211699
  NPD (past)

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

{
    "created_epoch": "1210204800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1663718400000",
    "number": "1326215468",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "21711 GREATER MACK AVE",
            "city": "SAINT CLAIR SHORES",
            "state": "MI",
            "postal_code": "480802418",
            "telephone_number": "586-774-0393",
            "fax_number": "586-777-2214"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "21711 GREATER MACK AVE",
            "city": "SAINT CLAIR SHORES",
            "state": "MI",
            "postal_code": "480802418",
            "telephone_number": "586-774-0393",
            "fax_number": "586-777-2214"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ST CLAIR SHORES MI OPHTHALMOLOGY ASC LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-05-08",
        "last_updated": "2022-09-21",
        "certification_date": "2022-09-21",
        "status": "A",
        "authorized_official_last_name": "SNODGRASS",
        "authorized_official_first_name": "JEFFREY",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "615-665-1283",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "261QA1903X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Ambulatory Surgical",
            "state": "MI",
            "license": "506812",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• St Claire Shores Medical PLLC

• Ambulatory Surgical Clinic/Center in Saint Clair Shores, MI
• Providers in Saint Clair Shores, MI by specialty
• Ambulatory Surgical Clinic/Center in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 21, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.