NPIMap

Organization Active NPI

Shoreline Optical, LLC

  • Eyewear Supplier
  • Muskegon, MI
National Provider Identifier
1114097359
Registry record updated May 22, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Eyewear SupplierTaxonomy code 332H00000X
Legal business name
SHORELINE OPTICAL, LLC
Practice address
1266 E Sherman Blvd
Muskegon, MI 49444-1847
Phone
(231) 739-9009
Fax
(231) 733-0566
NPI assigned
Nov 8, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 22, 2024

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Andrea Lynn Patrick
Title
Account Manager
Phone
(616) 588-6593

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Durable Medical Equipment & Medical Supplies 332B00000X
Eyewear Supplier 332H00000X Primary

Addresses

Primary practice location

1266 E Sherman Blvd
Muskegon, MI 49444-1847

Mailing address

1266 E. Sherman Blvd.
Muskegon, MI 49444
Phone (231) 739-9009

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MI

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20130411000301 MI DME Supplier - Physician - OphthalmologyDME Supplier - Physician - Optometrist 6507017324 Practice locations: Muskegon, MI

Other NPIs with the same Medicare PAC ID 2

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

National Provider Directory

National Provider Directory
Tax ID family
Shoreline Optical LLC3 organizations share this tax ID, including this one

Other organizations with this tax ID 2

Organizations that report the same tax identification number in the National Provider Directory.

Member of 1

Organizations this organization is a member of, according to the National Provider Directory.

Practitioners & affiliated clinicians

Practitioners 9

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1162944000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1716336000000",
    "number": "1114097359",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1266 E. SHERMAN BLVD.",
            "city": "MUSKEGON",
            "state": "MI",
            "postal_code": "49444",
            "telephone_number": "231-739-9009",
            "fax_number": "231-733-0566"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1266 E SHERMAN BLVD",
            "city": "MUSKEGON",
            "state": "MI",
            "postal_code": "494441847",
            "telephone_number": "231-739-9009",
            "fax_number": "231-733-0566"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SHORELINE OPTICAL, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-11-08",
        "last_updated": "2024-05-22",
        "certification_date": "2024-05-22",
        "status": "A",
        "authorized_official_last_name": "PATRICK",
        "authorized_official_first_name": "ANDREA",
        "authorized_official_middle_name": "LYNN",
        "authorized_official_title_or_position": "ACCOUNT MANAGER",
        "authorized_official_telephone_number": "616-588-6593"
    },
    "taxonomies": [
        {
            "code": "332B00000X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "332H00000X",
            "taxonomy_group": "",
            "desc": "Eyewear Supplier",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Muskegon, MI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 22, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.