Healthcare Provider Details

I. General information

NPI: 1962485342
Provider Name (Legal Business Name): LANSING OPHTHALMOLOGY, P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/21/2005
Last Update Date: 10/31/2024
Certification Date: 10/31/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2001 COOLIDGE RD
EAST LANSING MI
48823-1378
US

IV. Provider business mailing address

1005 CHARLEVOIX DR STE 100
GRAND LEDGE MI
48837-8186
US

V. Phone/Fax

Practice location:
  • Phone: 517-337-1668
  • Fax: 517-337-1779
Mailing address:
  • Phone: 517-337-1668
  • Fax: 517-622-1205

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207WX0009X
TaxonomyGlaucoma Specialist (Ophthalmology) Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207WX0107X
TaxonomyRetina Specialist (Ophthalmology) Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code207WX0200X
TaxonomyOphthalmic Plastic and Reconstructive Surgery Physician
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code363AS0400X
TaxonomySurgical Physician Assistant
License Number
License Number State
# 5
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number
License Number State

VIII. Authorized Official

Name: DONALD SHOOK
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 517-337-1899