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NPI Code Detail

MEDICARE: GRO OPTICAL, LLC

MEDICARE: GRO OPTICAL, LLC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1332H00000XEyewear Supplier

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1540D105120OTHERMIBCBS OF MI

General Provider Information

NPI Number : 1700917440
Entity Type Code : Organization
Provider Name (Legal Business Name) : GRO OPTICAL, LLC
Provider Business Mailing Address
First Line : 750 E BELTLINE AVE NE
Second Line :
City : GRAND RAPIDS
State : MI
Zip : 49525-6049
Country : US
Telephone Number : 616-942-1350
Fax Number : 616-949-1670
Provider Business Practice Location Address
First Line : 537 W MAIN ST
Second Line :
City : IONIA
State : MI
Zip : 48846-1652
Country : US
Telephone Number : 616-523-2020
Fax Number : 616-527-3756
Authorized Official
Title or Position : CEO
Name : MR. KELLY MCCRANN
Credential :
Telephone Number : 636-227-2600
Provider Enumeration Date : 03/07/2007
Last Update Date : 02/15/2021

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Directions to “GRO OPTICAL, LLC ” Practice Location

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