Lake Lazer Eye Center

Primary specialty

Preferred Provider OrganizationTaxonomy code 305R00000X

License

SK070791 Issued in MI

Legal business name

LAKE LAZER EYE CENTER

Practice address

44000 W 12 Mile Rd
Suite 112
Novi, MI 48377-2644

Phone

(586) 792-3891

NPI assigned

Oct 16, 2007

Last updated

May 6, 2008By the provider in NPPES

Organization subpart

Yes

Parent organization

LAKE LAZER EYE CENTERAs reported in NPPES

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

Authorized official

Name

Dr. Shabbir Khambati, MDNPI 1104938257

Title

Preident

Phone

(586) 792-3891

Specialties & licenses 1

Addresses

Other identifiers 5

Medicare fee-for-service enrollment

Enrolled in MI

Enrollment records 1

Other NPIs on the same Medicare enrollment 1

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

• Lake Lazer Eye Center PC

  • Ophthalmology Physician
  • Clinton TWP, MI
  • NPI 1003951575

  O20070314000217

  Same enrollment

Part of

Lake Lazer Eye Center PC

Locations

Parent organization (reported in NPPES) 1

This organization reports itself as a subpart in NPPES; the parent’s legal name matches this organization in the same state.

• Lake Lazer Eye Center PC

  • Ophthalmology Physician
  • Clinton TWP, MI
  • NPI 1003951575
  NPPES parent name

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.

• Shabbir Khambati, MD

  • Ophthalmology Physician
  • Clinton TWP, MI
  • NPI 1104938257
  NPD Authorized official
• Krystyn Kudla, O.D.

  • Optometrist
  • Detroit, MI
  • NPI 1164805099
  NPD

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

{
    "created_epoch": "1192492800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1210032000000",
    "number": "1376732388",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "44000 W 12 MILE RD",
            "city": "NOVI",
            "state": "MI",
            "postal_code": "483772644",
            "telephone_number": "586-792-3891"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "44000 W 12 MILE RD",
            "address_2": "SUITE 112",
            "city": "NOVI",
            "state": "MI",
            "postal_code": "483772644",
            "telephone_number": "586-792-3891"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LAKE LAZER EYE CENTER",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "LAKE LAZER EYE CENTER",
        "enumeration_date": "2007-10-16",
        "last_updated": "2008-05-06",
        "status": "A",
        "authorized_official_last_name": "KHAMBATI",
        "authorized_official_first_name": "SHABBIR",
        "authorized_official_title_or_position": "PREIDENT",
        "authorized_official_telephone_number": "586-792-3891",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "305R00000X",
            "taxonomy_group": "",
            "desc": "Preferred Provider Organization",
            "state": "MI",
            "license": "SK070791",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "4606945",
            "state": "MI"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "GREAT LAKES",
            "identifier": "140631",
            "state": "MI"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CARE NETWORK",
            "identifier": "0501160",
            "state": "MI"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS BLUE SHIELD",
            "identifier": "0501160",
            "state": "MI"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "HAP",
            "identifier": "H42351",
            "state": "MI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Kelsey Marie Lahner
• Jennifer Lahusky
• Nadine Sadia Laila, OD
• Stephanie Laird, LLP, BCBA
• Thomas Micheal Laird
• Lakes Chiropractic PLLC
• Lauren Elizabeth Lakin, AGPCNP-BC
• Alyssa Lalonde
• Annette Lalonde
• Caitlyn Lalone

• Preferred Provider Organization in Novi, MI
• Providers in Novi, MI by specialty
• Preferred Provider Organization in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 6, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.