Grand Lake Eyecare, LLC
Organization Active NPI Optometrist · Fort Recovery, OH
NPI 1487083697 · NPPES record last updated Nov 7, 2013
Key facts
- NPI
- 1487083697
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Optometrist 152W00000X
- Legal business name
- GRAND LAKE EYECARE, LLC
- Practice address
- 130 N. Wayne St
Fort Recovery, OH 45846-0645 - Phone
- (419) 375-5665
- Fax
- (419) 375-5667
- NPI assigned
- Nov 7, 2013
- Organization subpart
- Yes
- Parent organization (as reported)
- GRAND LAKE EYECARE, LLC
Authorized official
- Name
- Dr. Brian Thomas Gerlach, OD, FAAO
- Title
- Owner
- Phone
- (419) 586-3151
Parent organization (reported in NPPES) 1
Practitioners 6
-
Lindsay M Dues, OD
-
Nicolette M Evans, O.D.
-
Brian T Gerlach, OD, FAAO
-
Christie M Grieshop, O.D.
Laboratory certificates & supplier records
CLIA laboratory certificates
| CLIA number | Laboratory | Certificate | Expires |
|---|---|---|---|
| 36D2140049 | Grand Lake Eyecare, LLC | Certificate of waiver | Nov 13, 2027 |
National Provider Directory
- Part of
- Grand Lake Eyecare LLC
Locations
2024 Holiday Dr
Celina, OH 45822
Phone (419) 586-3151
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Optometrist |
152W00000X | Yes |
Addresses
Primary practice location
130 N. Wayne St
Fort Recovery, OH 45846-0645
Mailing address
PO Box 645
Fort Recovery, OH 45846-0645
Phone (419) 375-5665
Other providers in Fort Recovery, OH
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Nov 7, 2013. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- 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.