1699084301 NPI number — LANSING OPHTHALMOLOGY, P.C.

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1699084301 NPI number — LANSING OPHTHALMOLOGY, P.C.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
LANSING OPHTHALMOLOGY, P.C.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
LO EYE CARE
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1699084301
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/20/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1005 CHARLEVOIX DR STE 100
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
GRAND LEDGE
Provider Business Mailing Address State Name:
MI
Provider Business Mailing Address Postal Code:
48837-8186
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
517-337-1668
Provider Business Mailing Address Fax Number:
517-622-1205

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
425 W GRAND RIVER AVE
Provider Second Line Business Practice Location Address:
SUITE F
Provider Business Practice Location Address City Name:
WILLIAMSTON
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
48895-1343
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
517-655-2037
Provider Business Practice Location Address Fax Number:
517-655-1983
Provider Enumeration Date:
09/29/2010

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
MCCLURE
Authorized Official First Name:
JEN
Authorized Official Middle Name:
Authorized Official Title or Position:
EXECUTIVE DIRECTOR
Authorized Official Telephone Number:
517-337-1899

Provider Taxonomy Codes

  • Taxonomy code: 152W00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207W00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)