Provider Demographics
NPI:1295924587
Name:EYE HEALTH OF HOUGHTON LAKE, P.L.L.C.
Entity type:Organization
Organization Name:EYE HEALTH OF HOUGHTON LAKE, P.L.L.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPTOMETRIST
Authorized Official - Prefix:
Authorized Official - First Name:LAUREN
Authorized Official - Middle Name:ELIZABETH
Authorized Official - Last Name:SKARNULIS
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:231-633-4210
Mailing Address - Street 1:8154 BEL CHERRIE DR
Mailing Address - Street 2:
Mailing Address - City:TRAVERSE CITY
Mailing Address - State:MI
Mailing Address - Zip Code:49686-1637
Mailing Address - Country:US
Mailing Address - Phone:231-633-4210
Mailing Address - Fax:989-366-6390
Practice Address - Street 1:2129 W HOUGHTON LAKE DR
Practice Address - Street 2:
Practice Address - City:HOUGHTON LAKE
Practice Address - State:MI
Practice Address - Zip Code:48629-8236
Practice Address - Country:US
Practice Address - Phone:989-366-6344
Practice Address - Fax:989-366-6390
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-23
Last Update Date:2007-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4901004270152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty