Healthcare Provider Details

I. General information

NPI: 1841474772
Provider Name (Legal Business Name): GREAT LAKES EYE INSTITUTE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/27/2007
Last Update Date: 09/29/2025
Certification Date: 09/29/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

406 W GENESEE ST
FRANKENMUTH MI
48734-1311
US

IV. Provider business mailing address

2393 SCHUST RD
SAGINAW MI
48603-1334
US

V. Phone/Fax

Practice location:
  • Phone: 989-652-2020
  • Fax: 989-652-9444
Mailing address:
  • Phone: 989-793-2820
  • Fax: 989-793-9132

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number4301040619
License Number StateMI

VIII. Authorized Official

Name: FARHAD SHOKOOHI
Title or Position: OWNER/MD
Credential: MD
Phone: 989-793-2820