Healthcare Provider Details

I. General information

NPI: 1508055914
Provider Name (Legal Business Name): LORO INVESTMENTS, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/22/2007
Last Update Date: 10/22/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3286 ALPINE AVE NW STE A
GRAND RAPIDS MI
49544-1668
US

IV. Provider business mailing address

6715 SUNBURST DR
PORTAGE MI
49024-1010
US

V. Phone/Fax

Practice location:
  • Phone: 616-784-7360
  • Fax: 616-784-0727
Mailing address:
  • Phone: 269-327-9023
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number4901002523
License Number StateMI

VIII. Authorized Official

Name: DR. GERALD ROZANOFF
Title or Position: PRESIDENT
Credential: O.D.
Phone: 616-784-7360