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General NPI Number Information
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NPI Number | 1689794596
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Entity Type | Organization
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Legal Business Name | GREAT LAKES EYE ASSOCIATES, PLC
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Dates
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Enumeration Date | 04/02/2007
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Last Update Date | 01/07/2014
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Provider Practice Location Address
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Address Line | 944 BALDWIN RD SUITE H
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City | LAPEER
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State | MI
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Zip | 48446-3089
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Country | US
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Telephone | 810-667-6408
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Fax | 810-667-6492
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Provider Business Mailing Address
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Address Line | 944 BALDWIN RD SUITE H
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City | LAPEER
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State | MI
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Zip | 48446-3089
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Country | US
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Telephone | 810-667-6408
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Fax | 810-667-6492
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Authorized Official
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Title or Position | OWNER
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Name | DR. ARTHUR J TATGE
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Credential | D.O.
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Telephone | 810-667-6408
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207W00000X
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Taxonomy Name | Ophthalmology Physician
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License Number | AT014727
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License Number State | MI
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