Organization
GREAT LAKES EYE INSTITUTE
Active
Organization subpart
No
Provider details
NPI number
Authorized official
FARHAD SHOKOOHI MD (OWNER/MD)
(989) 793-2820
Entity
Organization
Contact information
Practice address
623 W WARWICK DR, SUITE 1, ALMA, MI 48801-1177
(989) 463-1126
(989) 463-6013
Mailing address
2393 SCHUST RD, SAGINAW, MI 48603-1334
(989) 793-2820
(989) 793-9132
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
—
—
207W00000X
Ophthalmology Physician
Primary
4301040619
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0467800006
ADMINASTAR
MI
01
—
0G36036
MEDICARE
—
01
—
180G300890
BLUE CARE NETWORK
MI
01
—
180G310710
BLUE CROSS BLUE SHIELD
MI
01
—
CA3610
RAILROAD MEDICARE
—
Enumeration date
12/27/2007
Last updated
01/23/2018
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