NPIMap

Organization Active NPI

Great Lakes Eye Institute

  • Ophthalmology Physician
  • Saginaw, MI
National Provider Identifier
1992985840
Registry record updated Aug 17, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Ophthalmology PhysicianTaxonomy code 207W00000X
License
4301040619 Issued in MI
Legal business name
GREAT LAKES EYE INSTITUTE
Practice address
2393 Schust Rd
Saginaw, MI 48603-1334
Phone
(989) 793-2820
Fax
(989) 793-9132
NPI assigned
Nov 8, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 17, 2018

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

Authorized official

Name
Farhad K Shokoohi, MDNPI 1275526048
Title
MD/Owner
Phone
(989) 793-2820

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 2

Specialty (taxonomy)CodeLicenseStatePrimary
OptometristGroup: 193200000X MULTI-SPECIALTY GROUP 152W00000X 4301040619 MI
Ophthalmology PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207W00000X 4301040619 MI Primary

Addresses

Primary practice location

2393 Schust Rd
Saginaw, MI 48603-1334

Mailing address

2393 Schust Rd
Saginaw, MI 48603-1334
Phone (989) 793-2820

Other practice location 1

407 W Wackerly St
Midland, MI 48640-4727
Phone (989) 631-1345

Other practice location 2

407 W Wackerly St
Midland, MI 48640-4727
Phone (989) 631-1345

Other identifiers 1

IdentifierTypeStateIssuer
1427090976OtherMIGROUP NPI

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MI

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20100930001804 MI DME Supplier - Physician - Ophthalmology 5799699534 Practice locations: Midland, MI

Other NPIs with the same Medicare PAC ID 5

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

National Provider Directory

National Provider Directory

Locations

623 W Warwick Dr
Ste 1
Alma, MI 48801
Phone (989) 285-1490

7328 N Alger Rd
Alma, MI 48801
Phone (517) 463-1126

Practitioners & affiliated clinicians

Practitioners 18

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

View all 18

NPI Registry JSON

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

{
    "created_epoch": "1194480000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1534464000000",
    "number": "1992985840",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2393 SCHUST RD",
            "city": "SAGINAW",
            "state": "MI",
            "postal_code": "486031334",
            "telephone_number": "989-793-2820",
            "fax_number": "989-793-9132"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2393 SCHUST RD",
            "city": "SAGINAW",
            "state": "MI",
            "postal_code": "486031334",
            "telephone_number": "989-793-2820",
            "fax_number": "989-793-9132"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "407 W Wackerly St",
            "address_purpose": "LOCATION",
            "city": "Midland",
            "state": "MI",
            "postal_code": "486404727",
            "country_code": "US",
            "telephone_number": "989-631-1345",
            "fax_number": "989-631-5129",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "407 W Wackerly St",
            "address_purpose": "LOCATION",
            "city": "Midland",
            "state": "MI",
            "postal_code": "486404727",
            "country_code": "US",
            "telephone_number": "989-631-1345",
            "fax_number": "989-631-5129",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "GREAT LAKES EYE INSTITUTE",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-11-08",
        "last_updated": "2018-08-17",
        "status": "A",
        "authorized_official_last_name": "SHOKOOHI",
        "authorized_official_first_name": "FARHAD",
        "authorized_official_middle_name": "K",
        "authorized_official_title_or_position": "MD/OWNER",
        "authorized_official_telephone_number": "989-793-2820",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Optometrist",
            "state": "MI",
            "license": "4301040619",
            "primary": false
        },
        {
            "code": "207W00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Ophthalmology",
            "state": "MI",
            "license": "4301040619",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "GROUP NPI",
            "identifier": "1427090976",
            "state": "MI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Saginaw, MI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 17, 2018; 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.