Provider Demographics
NPI:1689110710
Name:W. OPTICAL 2 LLC
Entity Type:Organization
Organization Name:W. OPTICAL 2 LLC
Other - Org Name:W. OPTICAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:AARON
Authorized Official - Middle Name:
Authorized Official - Last Name:WINTERS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:616-432-3591
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 1:3233 ALPINE AVE NW STE A
Practice Address - Street 2:
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49544-1631
Practice Address - Country:US
Practice Address - Phone:616-432-3591
Practice Address - Fax:616-432-3597
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-01-12
Last Update Date:2019-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOpticianGroup - Single Specialty