Provider Demographics
NPI:1609960863
Name:MARK E STEMPIHAR, M.D., P.C.
Entity Type:Organization
Organization Name:MARK E STEMPIHAR, M.D., P.C.
Other - Org Name:GREAT LAKES EYE SPECIALISTS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:BUSINESS ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:PAMELA
Authorized Official - Middle Name:
Authorized Official - Last Name:BRETALL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:906-932-1436
Mailing Address - Street 1:E6112 E BLUFFVIEW RD
Mailing Address - Street 2:SUITE 102
Mailing Address - City:IRONWOOD
Mailing Address - State:MI
Mailing Address - Zip Code:49938-9367
Mailing Address - Country:US
Mailing Address - Phone:906-932-1436
Mailing Address - Fax:
Practice Address - Street 1:E6112 E BLUFFVIEW RD
Practice Address - Street 2:SUITE 102
Practice Address - City:IRONWOOD
Practice Address - State:MI
Practice Address - Zip Code:49938-9367
Practice Address - Country:US
Practice Address - Phone:906-932-1436
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-03
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4901004267152W00000X
MI4901003062152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4733142Medicaid
MIT33322Medicare UPIN
MI0P14480Medicare ID - Type UnspecifiedOPTOMETRIST GROUP
MIP14480001Medicare ID - Type UnspecifiedCARRINGTON INDIVIDUAL
MI4733142Medicaid