Organization
GREAT LAKES EYE SURGERY CENTER LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. FARHAD K SHOKOOHI M.D. (OWNER)
(989) 793-2820
Entity
Organization
Contact information
Practice address
2393 SCHUST RD, SAGINAW, MI 48603-1334
(989) 793-2820
(989) 793-9132
Mailing address
2393 SCHUST RD, SAGINAW, MI 48603-1334
(989) 793-2820
(989) 793-9132
Taxonomy
Speciality
Code
Description
License number
State
261QA1903X
Ambulatory Surgical Clinic/Center
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0G31248
BLUE CROSS
MI
Enumeration date
08/30/2006
Last updated
10/12/2007
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