Provider Demographics
NPI:1326206186
Name:316 OPTOMETRY LLC
Entity Type:Organization
Organization Name:316 OPTOMETRY LLC
Other - Org Name:316 OPTOMETRY LLC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MARIA
Authorized Official - Middle Name:LYN-SHOOP
Authorized Official - Last Name:GARCIA
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:269-268-5140
Mailing Address - Street 1:172 CHURCH ST
Mailing Address - Street 2:
Mailing Address - City:COLDWATER
Mailing Address - State:MI
Mailing Address - Zip Code:49036-1756
Mailing Address - Country:US
Mailing Address - Phone:269-268-5140
Mailing Address - Fax:517-278-2199
Practice Address - Street 1:800 E CHICAGO ST
Practice Address - Street 2:
Practice Address - City:COLDWATER
Practice Address - State:MI
Practice Address - Zip Code:49036-2055
Practice Address - Country:US
Practice Address - Phone:517-278-2809
Practice Address - Fax:517-278-2199
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-29
Last Update Date:2022-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
152W00000X
MI4901003648332H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
No332H00000XSuppliersEyewear SupplierGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI944205383Medicaid
MI4314030001Medicare NSC
MI0N11140Medicare PIN
MIU35798Medicare UPIN