Healthcare Provider Details

I. General information

NPI: 1326206186
Provider Name (Legal Business Name): 316 OPTOMETRY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/29/2008
Last Update Date: 11/22/2022
Certification Date: 11/22/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

800 E CHICAGO ST
COLDWATER MI
49036-2055
US

IV. Provider business mailing address

172 CHURCH ST
COLDWATER MI
49036-1756
US

V. Phone/Fax

Practice location:
  • Phone: 517-278-2809
  • Fax: 517-278-2199
Mailing address:
  • Phone: 269-268-5140
  • Fax: 517-278-2199

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code332H00000X
TaxonomyEyewear Supplier
License Number4901003648
License Number StateMI

VIII. Authorized Official

Name: DR. MARIA LYN-SHOOP GARCIA
Title or Position: OWNER
Credential: OD
Phone: 269-268-5140