Organization
GREAT LAKES INDEPENDENT EYECARE NETWORK LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
HEIDI L JOHNSON OD (PRESIDENT)
(906) 228-4401
Entity
Organization
Contact information
Practice address
W4790 SKI VIEW RD, VULCAN, MI 49892-8720
(877) 488-8900
(844) 810-8643
Mailing address
2425 LUDINGTON ST, PMB 175, ESCANABA, MI 49829-1328
(906) 466-9070
(906) 466-9071
Taxonomy
Speciality
Code
Description
License number
State
302F00000X
Exclusive Provider Organization
Primary
—
—
Other
Enumeration date
08/20/2012
Last updated
04/10/2024
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