Great Lakes Eye Care PC

Primary specialty

Ophthalmology PhysicianTaxonomy code 207W00000X

License

4301046231 Issued in MI

Legal business name

GREAT LAKES EYE CARE PC

Practice address

2848 Niles Rd
Saint Joseph, MI 49085-3352

Phone

(269) 428-3300

Fax

(269) 428-5005

NPI assigned

Jun 9, 2005

Organization subpart

No

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

Authorized official

Name

Dr. David Locke Cooke, M.D.NPI 1942205315

Title

President Owner

Phone

(269) 428-3300

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• Great Lakes Eye Care Doing business as

Medicare fee-for-service enrollment

Enrolled in MI, IN4 enrollments

Enrollment records 4

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

CLIA laboratory certificates

Medicare medical equipment & supply locations

Locations

Practitioners 13

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• David Locke Cooke, M.D.

  • Ophthalmology Physician
  • Saint Joseph, MI
  • NPI 1942205315
  Medicare reassignment Care Compare group Authorized official
• Nicholas George Keinath, OD

  • Optometrist
  • Saint Joseph, MI
  • NPI 1124886460

  IN

  Medicare reassignment Care Compare group NPD
• Rachel McKuras

  • Optometrist
  • Saint Joseph, MI
  • NPI 1932953205

  IN

  Medicare reassignment Care Compare group NPD
• Trevor Alan Smith, M.D.

  • Ophthalmology Physician
  • Wyoming, MI
  • NPI 1376957043
  Medicare reassignment Care Compare group NPD
• Alexander Ray Stoddard, MD

  • Ophthalmology Physician
  • Saint Joseph, MI
  • NPI 1437651676
  Medicare reassignment Care Compare group NPD
• Jenna Elise Stoddard, OD

  • Optometrist
  • Saint Joseph, MI
  • NPI 1184101602
  Medicare reassignment Care Compare group NPD
• Duane Allen Tolsma, O.D.

  • Optometrist
  • Saint Joseph, MI
  • NPI 1306841630
  Medicare reassignment Care Compare group NPD
• Daniel James Van Elk, OD

  • Optometrist
  • Saint Joseph, MI
  • NPI 1194216937
  Medicare reassignment Care Compare group NPD
• David Neal Brown, M.D.

  • Ophthalmology Physician
  • Saint Joseph, MI
  • NPI 1265437370

  IN

  Medicare reassignment Care Compare group
• Benjamin P Nicholson, M.D., M.A.

  • Retina Specialist (Ophthalmology) Physician
  • Saint Joseph, MI
  • NPI 1003016916

  IN

  Medicare reassignment Care Compare group
• Stanley W Pletcher, M.D.

  • Ophthalmology Physician
  • Saint Joseph, MI
  • NPI 1427053826
  Medicare reassignment Care Compare group
• Andrew Manongdo Wang, M.D.

  • Ophthalmology Physician
  • Saint Joseph, MI
  • NPI 1992701098
  Medicare reassignment Care Compare group

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

{
    "created_epoch": "1118275200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1674691200000",
    "number": "1922002708",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2848 NILES RD",
            "city": "SAINT JOSEPH",
            "state": "MI",
            "postal_code": "490853352",
            "telephone_number": "269-428-3300",
            "fax_number": "269-428-5005"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2848 NILES RD",
            "city": "SAINT JOSEPH",
            "state": "MI",
            "postal_code": "490853352",
            "telephone_number": "269-428-3300",
            "fax_number": "269-428-5005"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GREAT LAKES EYE CARE PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-06-09",
        "last_updated": "2023-01-26",
        "certification_date": "2023-01-26",
        "status": "A",
        "authorized_official_last_name": "COOKE",
        "authorized_official_first_name": "DAVID",
        "authorized_official_middle_name": "LOCKE",
        "authorized_official_title_or_position": "PRESIDENT OWNER",
        "authorized_official_telephone_number": "269-428-3300",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "207W00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Ophthalmology",
            "state": "MI",
            "license": "4301046231",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1878128",
            "state": "MI"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Great Lakes Eye Care",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Great Lakes Eye Care",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Allie Gordian
• John R Gosling, MD
• Heidi Marie Grabemeyer-Layman, M.D.
• Tamara L Grady, PA
• Albert Grashuis, LPC
• Great Lakes Family Dental Group-St. Joseph
• Great Lakes Gastroenterology PLLC
• Great Lakes Heart & Vascular Institute, P.C.
• Great Lakes Sports Medicine and Concussion Clinic
• Great Lakes Surgery Center LLC

• Ophthalmology Physician in Saint Joseph, MI
• Providers in Saint Joseph, MI by specialty
• Ophthalmology Physician in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 26, 2023; 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.