Healthcare Provider Details

I. General information

NPI: 1689110710
Provider Name (Legal Business Name): W. OPTICAL 2 LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/12/2017
Last Update Date: 12/18/2019
Certification Date: 12/18/2019
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3233 ALPINE AVE NW STE A
GRAND RAPIDS MI
49544-1631
US

IV. Provider business mailing address

3233 ALPINE AVE NW STE A
GRAND RAPIDS MI
49544-1631
US

V. Phone/Fax

Practice location:
  • Phone: 616-432-3591
  • Fax: 616-432-3597
Mailing address:
  • Phone: 616-432-3591
  • Fax: 616-432-3597

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code156FX1800X
TaxonomyOptician
License Number
License Number State

VIII. Authorized Official

Name: MR. AARON WINTERS
Title or Position: CEO
Credential:
Phone: 616-432-3591