Provider Demographics
NPI:1962485342
Name:LANSING OPHTHALMOLOGY, P.C.
Entity Type:Organization
Organization Name:LANSING OPHTHALMOLOGY, P.C.
Other - Org Name:LO EYE CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:JEN
Authorized Official - Middle Name:
Authorized Official - Last Name:MCCLURE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:517-337-1899
Mailing Address - Street 1:1005 CHARLEVOIX DR STE 100
Mailing Address - Street 2:
Mailing Address - City:GRAND LEDGE
Mailing Address - State:MI
Mailing Address - Zip Code:48837-8186
Mailing Address - Country:US
Mailing Address - Phone:517-337-1668
Mailing Address - Fax:517-622-1205
Practice Address - Street 1:2001 COOLIDGE RD
Practice Address - Street 2:
Practice Address - City:EAST LANSING
Practice Address - State:MI
Practice Address - Zip Code:48823-1378
Practice Address - Country:US
Practice Address - Phone:517-337-1668
Practice Address - Fax:517-337-1779
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-11-21
Last Update Date:2022-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
No152W00000XEye and Vision Services ProvidersOptometristGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MICE4235OtherRAILROAD MEDICARE
MI180C36002OtherBCBSM
MICE4235OtherRAILROAD MEDICARE
MICE4235OtherRAILROAD MEDICARE