Grand Lake Eyecare, LLC

NPI #1487083697 in Fort Recovery, Ohio

Provider Information

NPI Number: 1487083697
Entity Type: Organization
Organization Name: Grand Lake Eyecare, LLC
Subpart: Yes (part of a larger organization)
Parent Organization: GRAND LAKE EYECARE, LLC
Primary Specialty: Optometrist
Enumeration Date: Nov 7, 2013
Last Updated: Nov 7, 2013

Practice Location

Address: 130 N. WAYNE ST
City: Fort Recovery
State: Ohio
ZIP Code: 45846-0645
Phone: (419) 375-5665

Authorized Official

Name: DR. BRIAN THOMAS GERLACH, OD, FAAO
Title: OWNER
Phone: (419) 586-3151

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Optometrist	152W00000X	Primary

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