MEDICARE: LANSING OPHTHALMOLOGY, P.C.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	152W00000X	Optometrist
2	207W00000X	Ophthalmology Physician

General Provider Information

NPI Number	:	1679898977
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LANSING OPHTHALMOLOGY, P.C.

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

Provider Business Practice Location Address
First Line	:	136 E GRAND RIVER AVE
Second Line	:
City	:	FOWLERVILLE
State	:	MI
Zip	:	48836-5136
Country	:	US
Telephone Number	:	517-223-9988
Fax Number	:	517-223-9071

Authorized Official
Title or Position	:	EXECUTIVE DIRECTOR
Name	:	DONALD SHOOK
Credential	:
Telephone Number	:	517-337-1899

Provider Enumeration Date	:	03/30/2010
Last Update Date	:	08/07/2024

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