Organization
GREAT LAKES EYE INSTITUTE
Active
Organization
GREAT LAKES EYE INSTITUTE
Active
Organization subpart
No
Provider details
NPI number
Authorized official
FARHAD K SHOKOOHI MD (MD/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
152W00000X
Optometrist
4301040619
MI
207W00000X
Ophthalmology Physician
Primary
4301040619
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1427090976
GROUP NPI
MI
Enumeration date
11/08/2007
Last updated
08/17/2018
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