Provider Demographics
NPI:1700407384
Name:LAKESHORE EYE SPECIALISTS PC
Entity Type:Organization
Organization Name:LAKESHORE EYE SPECIALISTS PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ENOCH
Authorized Official - Middle Name:
Authorized Official - Last Name:ENOCH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:260-467-3682
Mailing Address - Street 1:115 ARNDT ST
Mailing Address - Street 2:
Mailing Address - City:MICHIGAN CITY
Mailing Address - State:IN
Mailing Address - Zip Code:46360-2321
Mailing Address - Country:US
Mailing Address - Phone:368-226-0467
Mailing Address - Fax:
Practice Address - Street 1:3777 N FRONTAGE RD
Practice Address - Street 2:
Practice Address - City:MICHIGAN CITY
Practice Address - State:IN
Practice Address - Zip Code:46360-7695
Practice Address - Country:US
Practice Address - Phone:368-226-0467
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-05-05
Last Update Date:2020-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty