NPIMap

Organization Active NPI

Grand Lake Eyecare, LLC

  • Optometrist
  • Fort Recovery, OH
National Provider Identifier
1487083697
Registry record updated Nov 7, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
OptometristTaxonomy code 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
Last updated
Nov 7, 2013By the provider in NPPES
Organization subpart
Yes
Parent organization
GRAND LAKE EYECARE, LLCAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Nov 7, 2013

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

Authorized official

Name
Dr. Brian Thomas Gerlach, OD, FAAONPI 1093776205
Title
Owner
Phone
(419) 586-3151

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 1

Specialty (taxonomy)CodeLicenseStatePrimary
OptometristGroup: 193400000X SINGLE SPECIALTY GROUP 152W00000X Primary

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

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.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
36D2140049Grand Lake Eyecare, LLC130 N Wayne St, Fort Recovery, OH 45846Certificate of waiverNov 13, 2027

National Provider Directory

National Provider Directory
Part of
Grand Lake Eyecare LLC

Locations

2024 Holiday Dr
Celina, OH 45822
Phone (419) 586-3151

Ownership & related parties

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.

Practitioners & affiliated clinicians

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.

NPI Registry JSON

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

{
    "created_epoch": "1383782400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1383782400000",
    "number": "1487083697",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 645",
            "city": "FORT RECOVERY",
            "state": "OH",
            "postal_code": "458460645",
            "telephone_number": "419-375-5665",
            "fax_number": "419-375-5667"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "130 N. WAYNE ST",
            "city": "FORT RECOVERY",
            "state": "OH",
            "postal_code": "458460645",
            "telephone_number": "419-375-5665",
            "fax_number": "419-375-5667"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GRAND LAKE EYECARE, LLC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "GRAND LAKE EYECARE, LLC",
        "enumeration_date": "2013-11-07",
        "last_updated": "2013-11-07",
        "status": "A",
        "authorized_official_last_name": "GERLACH",
        "authorized_official_first_name": "BRIAN",
        "authorized_official_middle_name": "THOMAS",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "419-586-3151",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "OD, FAAO"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Optometrist",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Fort Recovery, OH

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 7, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • 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.