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General NPI Number Information
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NPI Number | 1598107971
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Entity Type | Organization
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Legal Business Name | W. OPTICAL
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Dates
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Enumeration Date | 07/25/2013
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Last Update Date | 07/26/2013
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Provider Practice Location Address
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Address Line | 13909 HALL RD
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City | SHELBY TWP
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State | MI
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Zip | 48315-6103
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Country | US
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Telephone | 616-821-4954
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Fax |
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Provider Business Mailing Address
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Address Line | 13909 HALL RD
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City | SHELBY TWP
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State | MI
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Zip | 48315-6103
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | MR. AARON ROBERT WINTERS
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Credential |
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Telephone | 616-821-4954
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 156FX1800X
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Taxonomy Name | Optician
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License Number |
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License Number State |
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