Healthcare Provider Details

I. General information

NPI: 1487785135
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: 02/15/2021
Certification Date: 02/15/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3235 N WELLNESS DR LAKESHORE MEDICAL CAMPUS
HOLLAND MI
49424-7264
US

IV. Provider business mailing address

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

V. Phone/Fax

Practice location:
  • Phone: 616-994-9586
  • Fax: 616-994-0105
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. KELLY MCCRANN
Title or Position: CEO
Credential:
Phone: 636-227-2600