Provider Demographics
NPI:1457771214
Name:GRO OPTICAL, LLC
Entity Type:Organization
Organization Name:GRO OPTICAL, LLC
Other - Org Name:GRAND RAPIDS OPTICIANS, LLC
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:KELLY
Authorized Official - Middle Name:
Authorized Official - Last Name:MCCRANN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:636-227-2600
Mailing Address - Street 1:10047 CROSSROAD CT SE
Mailing Address - Street 2:
Mailing Address - City:CALEDONIA
Mailing Address - State:MI
Mailing Address - Zip Code:49316-7316
Mailing Address - Country:US
Mailing Address - Phone:616-588-6556
Mailing Address - Fax:
Practice Address - Street 1:10047 CROSSROAD CT SE
Practice Address - Street 2:
Practice Address - City:CALEDONIA
Practice Address - State:MI
Practice Address - Zip Code:49316-7316
Practice Address - Country:US
Practice Address - Phone:616-588-6556
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-04-21
Last Update Date:2021-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332H00000XSuppliersEyewear Supplier