Organization
GREAT LAKES EYE INSTITUTE
Active
Organization subpart
No
Provider details
NPI number
Authorized official
FARHAD KAYVAN 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
207W00000X
Ophthalmology Physician
43010040619
MI
207WX0107X
Retina Specialist (Ophthalmology) Physician
Primary
4301102705
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0G36036
MEDICARE
—
01
—
180G300890
FEDERAL EMPLOYEES PROGRAM BLUE CROSS
MI
01
—
CA3610
RR MEDICARE
MI
Enumeration date
06/11/2006
Last updated
09/29/2025
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