Grand Lake Eyecare LLC

NPI #1548301690 in Celina, Ohio

Provider Information

NPI Number: 1548301690
Entity Type: Organization
Organization Name: Grand Lake Eyecare LLC
Primary Specialty: Optometrist
Enumeration Date: Feb 10, 2007
Last Updated: Feb 5, 2008

Practice Location

Address: 1025 GRAND LAKE RD
City: Celina
State: Ohio
ZIP Code: 45822-1309
Phone: (419) 586-3151

Authorized Official

Name: DR. KENNETH J SANDKER, OD
Title: PARTNER
Phone: (419) 586-3151

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Durable Medical Equipment & Medical Supplies	332B00000X
Eyewear Supplier	332H00000X
Optometrist	152W00000X	Primary

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