Healthcare Provider Details

I. General information

NPI: 1699079160
Provider Name (Legal Business Name): SHORELINE OPHTHALMOLOGY PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/27/2010
Last Update Date: 05/09/2022
Certification Date: 05/09/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

625 E SAVIDGE ST
SPRING LAKE MI
49456-1956
US

IV. Provider business mailing address

1266 E SHERMAN BLVD
MUSKEGON MI
49444-1847
US

V. Phone/Fax

Practice location:
  • Phone: 616-846-2280
  • Fax: 616-844-5696
Mailing address:
  • Phone: 231-739-9009
  • Fax: 616-844-5696

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number
License Number State

VIII. Authorized Official

Name: DR. JOSEPH GIRA
Title or Position: OWNER
Credential:
Phone: 231-739-9009