Provider Demographics
NPI:1275045916
Name:W. OPTICAL 4 LLC
Entity Type:Organization
Organization Name:W. OPTICAL 4 LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:W-HOLDING LLC CEO
Authorized Official - Prefix:
Authorized Official - First Name:AARON
Authorized Official - Middle Name:
Authorized Official - Last Name:WINTERS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:616-512-4992
Mailing Address - Street 1:3233 ALPINE AVE NW STE A
Mailing Address - Street 2:
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49544-1631
Mailing Address - Country:US
Mailing Address - Phone:616-432-3591
Mailing Address - Fax:616-432-3597
Practice Address - Street 1:1004 28TH ST SW
Practice Address - Street 2:
Practice Address - City:WYOMING
Practice Address - State:MI
Practice Address - Zip Code:49509-2881
Practice Address - Country:US
Practice Address - Phone:444-393-3928
Practice Address - Fax:844-439-3392
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-11-03
Last Update Date:2019-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOpticianGroup - Single Specialty