Lakeshore Opticians

Primary specialty

Eyewear SupplierTaxonomy code 332H00000X

Legal business name

LAKESHORE OPTICIANS

Practice address

717 Bagley Ave SE
Grand Rapids, MI 49506-3001

Phone

(616) 451-0896

NPI assigned

Mar 5, 2008

Organization subpart

No

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

Authorized official

Name

Mr. Michael Vanderbaan, OPTICIAN

Title

Owner

Phone

(616) 451-0896

Specialties & licenses 1

Addresses

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

{
    "created_epoch": "1204675200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1204675200000",
    "number": "1851561906",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "717 BAGLEY AVE SE",
            "city": "GRAND RAPIDS",
            "state": "MI",
            "postal_code": "495063001",
            "telephone_number": "616-451-0896"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "717 BAGLEY AVE SE",
            "city": "GRAND RAPIDS",
            "state": "MI",
            "postal_code": "495063001",
            "telephone_number": "616-451-0896"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LAKESHORE OPTICIANS",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-03-05",
        "last_updated": "2008-03-05",
        "status": "A",
        "authorized_official_last_name": "VANDERBAAN",
        "authorized_official_first_name": "MICHAEL",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "616-451-0896",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "OPTICIAN"
    },
    "taxonomies": [
        {
            "code": "332H00000X",
            "taxonomy_group": "",
            "desc": "Eyewear Supplier",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Candice M Lake, BCBA-D, LLP
• Dennis Lake, M.D.
• Eric S Lake, MA,LLP, CADC
• Suzanne Rae Lake, RPH
• Laker Prosthetics
• Nehal Jagdish Lakhani, M.D.
• Govinda Sai Lakshmanan
• Keshav Lalchandani
• Jessica Jane Lalley, MD
• Brigid Kate Lally

• Eyewear Supplier in Grand Rapids, MI
• Providers in Grand Rapids, MI by specialty
• Eyewear Supplier in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 5, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.