NPIMap

Organization Active NPI

Great Lakes Eye Institute

  • Ophthalmology Physician
  • Alma, MI
National Provider Identifier
1346424272
Registry record updated Jan 23, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Ophthalmology PhysicianTaxonomy code 207W00000X
License
4301040619 Issued in MI
Legal business name
GREAT LAKES EYE INSTITUTE
Practice address
623 W Warwick Dr
Suite 1
Alma, MI 48801-1177
Phone
(989) 463-1126
Fax
(989) 463-6013
NPI assigned
Dec 27, 2007
Last updated
Jan 23, 2018By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 23, 2018

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

Authorized official

Name
Farhad Shokoohi, MDNPI 1275526048
Title
Owner/MD
Phone
(989) 793-2820

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Optometrist 152W00000X NU
Ophthalmology Physician 207W00000X 4301040619 MI Primary

Addresses

Primary practice location

623 W Warwick Dr
Suite 1
Alma, MI 48801-1177

Mailing address

2393 Schust Rd
Saginaw, MI 48603-1334
Phone (989) 793-2820

Other identifiers 6

IdentifierTypeStateIssuer
0G36036OtherMEDICARE
CA3610OtherRAILROAD MEDICARE
180G300890OtherMIBLUE CARE NETWORK
180G310710OtherMIBLUE CROSS BLUE SHIELD
180G300890OtherMIBLUE CROSS BLUE SHIELD
0467800006OtherMIADMINASTAR

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MI

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20100930008081 MI DME Supplier - Physician - OphthalmologyDME Supplier - Optician 5799699534 1 other NPI on this enrollment
Practice locations: Alma, MI

Other NPIs with the same Medicare PAC ID 5

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

Other NPIs on the same Medicare enrollment 1

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

Medicare medical equipment & supply locations

SupplierSuppliesMedicare assignment
Great Lakes Eye Institute623 W Warwick Dr, Alma, MI 48801-1177(898) 463-1126 Ocular Prostheses|Prosthetic Lenses: Conventional Eyeglasses|Prosthetic Lenses: Conventional Contact Lenses|Prosthetic Lenses: Prosthetics Cataract Lenses Accepts assignmentParticipating since Jan 1, 2000

National Provider Directory

National Provider Directory
Tax ID family
Great Lakes Eye Institute4 organizations share this tax ID, including this one

Other organizations with this tax ID 3

Organizations that report the same tax identification number in the National Provider Directory.

Practitioners & affiliated clinicians

Practitioners 2

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.

NPI Registry JSON

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

{
    "created_epoch": "1198713600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1516665600000",
    "number": "1346424272",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2393 SCHUST RD",
            "city": "SAGINAW",
            "state": "MI",
            "postal_code": "486031334",
            "telephone_number": "989-793-2820",
            "fax_number": "989-793-9132"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "623 W WARWICK DR",
            "address_2": "SUITE 1",
            "city": "ALMA",
            "state": "MI",
            "postal_code": "488011177",
            "telephone_number": "989-463-1126",
            "fax_number": "989-463-6013"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GREAT LAKES EYE INSTITUTE",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-12-27",
        "last_updated": "2018-01-23",
        "status": "A",
        "authorized_official_last_name": "SHOKOOHI",
        "authorized_official_first_name": "FARHAD",
        "authorized_official_title_or_position": "OWNER/MD",
        "authorized_official_telephone_number": "989-793-2820",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "207W00000X",
            "taxonomy_group": "",
            "desc": "Ophthalmology",
            "state": "MI",
            "license": "4301040619",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE",
            "identifier": "0G36036",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICARE",
            "identifier": "CA3610",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CARE NETWORK",
            "identifier": "180G300890",
            "state": "MI"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS BLUE SHIELD",
            "identifier": "180G310710",
            "state": "MI"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS BLUE SHIELD",
            "identifier": "180G300890",
            "state": "MI"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "ADMINASTAR",
            "identifier": "0467800006",
            "state": "MI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Alma, MI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 23, 2018; 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.