Provider Demographics
NPI:1790841658
Name:SHORELINE OPHTHALMOLOGY, PLLC
Entity Type:Organization
Organization Name:SHORELINE OPHTHALMOLOGY, PLLC
Other - Org Name:SHORELINE OPHTHALMOLOGY GRAND HAVEN
Other - Org Type:Other Name
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:
Authorized Official - Last Name:GIRA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:231-739-9009
Mailing Address - Street 1:1266 E SHERMAN BLVD
Mailing Address - Street 2:
Mailing Address - City:MUSKEGON
Mailing Address - State:MI
Mailing Address - Zip Code:49444-1847
Mailing Address - Country:US
Mailing Address - Phone:231-739-9009
Mailing Address - Fax:231-733-0566
Practice Address - Street 1:1445 SHELDON RD STE 100
Practice Address - Street 2:HARBOR DUNES HEALTH CENTER
Practice Address - City:GRAND HAVEN
Practice Address - State:MI
Practice Address - Zip Code:49417-2479
Practice Address - Country:US
Practice Address - Phone:231-739-9009
Practice Address - Fax:231-733-0566
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-28
Last Update Date:2022-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty