Organization
GRAND LAKE EYECARE, LLC
Active
Parent organization
GRAND LAKE EYECARE, LLC
Organization subpart
Yes
Provider details
NPI number
Legal business name
GRAND LAKE EYECARE, LLC
Authorized official
DR. BRIAN THOMAS GERLACH OD, FAAO (OWNER)
(419) 586-3151
Entity
Organization
Contact information
Practice address
130 N. WAYNE ST, FORT RECOVERY, OH 45846-0645
(419) 375-5665
(419) 375-5667
Mailing address
PO BOX 645, FORT RECOVERY, OH 45846-0645
(419) 375-5665
(419) 375-5667
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
—
—
Other
Enumeration date
11/07/2013
Last updated
11/07/2013
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