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General NPI Number Information
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NPI Number | 1972808921
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Entity Type | Organization
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Legal Business Name | SHORELINE OPTICAL, LLC
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Dates
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Enumeration Date | 01/24/2011
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Last Update Date | 05/22/2024
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Provider Practice Location Address
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Address Line | 625 E SAVIDGE ST
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City | SPRING LAKE
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State | MI
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Zip | 49456-1956
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Country | US
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Telephone | 231-739-9009
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Fax |
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Provider Business Mailing Address
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Address Line | 1266 E SHERMAN BLVD
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City | MUSKEGON
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State | MI
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Zip | 49444-1847
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Country | US
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Telephone | 616-846-2280
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Fax | 616-844-5696
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Authorized Official
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Title or Position | ACCOUNT MANAGER
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Name | ANDREA LYNN PATRICK
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Credential |
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Telephone | 616-588-6593
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 332H00000X
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Taxonomy Name | Eyewear Supplier
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License Number |
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License Number State |
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