Organization
GREAT LAKES EYE CONSULTANTS PLC
Active
Organization
GREAT LAKES EYE CONSULTANTS PLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. PETER FEDOR M.D. (OWNER)
(231) 947-1690
Entity
Organization
Contact information
Practice address
872 MUNSON AVE, SUITE B, TRAVERSE CITY, MI 49686
(231) 947-1690
(231) 947-1692
Mailing address
PO BOX 308, ACME, MI 49610-0308
(231) 947-1690
(231) 947-1692
Taxonomy
Speciality
Code
Description
License number
State
207W00000X
Ophthalmology Physician
Primary
4301061885
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
104609633
—
MI
05
—
104609642
—
MI
05
—
104609651
—
MI
05
—
104609660
—
MI
Enumeration date
03/07/2007
Last updated
05/22/2018
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