Healthcare Provider Details

I. General information

NPI: 1154452829
Provider Name (Legal Business Name): GRO OPTICAL, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/07/2007
Last Update Date: 03/09/2023
Certification Date: 03/09/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

705 S GREENVILLE WEST DR STE 201
GREENVILLE MI
48838-3531
US

IV. Provider business mailing address

750 E BELTLINE AVE NE
GRAND RAPIDS MI
49525-6049
US

V. Phone/Fax

Practice location:
  • Phone: 616-754-5667
  • Fax: 616-754-3071
Mailing address:
  • Phone: 616-942-1350
  • Fax: 616-949-1670

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332H00000X
TaxonomyEyewear Supplier
License Number
License Number State

VIII. Authorized Official

Name: MR. DAVID CLARK
Title or Position: CEO
Credential:
Phone: 636-227-2600