NPIMap

Organization Active NPI

Gro Optical, LLC

  • Eyewear Supplier
  • Greenville, MI
National Provider Identifier
1154452829
Registry record updated Mar 9, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Eyewear SupplierTaxonomy code 332H00000X
Legal business name
GRO OPTICAL, LLC
Practice address
705 S Greenville West Dr Ste 201
Greenville, MI 48838-3531
Phone
(616) 754-5667
Fax
(616) 754-3071
NPI assigned
Mar 7, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 9, 2023

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

Authorized official

Name
Mr. David Clark
Title
Ceo
Phone
(636) 227-2600

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Eyewear Supplier 332H00000X Primary

Addresses

Primary practice location

705 S Greenville West Dr Ste 201
Greenville, MI 48838-3531

Mailing address

750 E Beltline Ave NE
Grand Rapids, MI 49525-6049
Phone (616) 942-1350

Other identifiers 1

IdentifierTypeStateIssuer
540D105120OtherMIBCBS OF MI

Other names 4

  • G.R.O. Optical Doing business as
  • G.R.O. Optical LLC Doing business as
  • GRO Optical LLC Doing business as
  • Grand Rapids Opticians, LLC Former legal business name

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20100930037436 MI DME Supplier - Physician - Ophthalmology 5193842128 Practice locations: Greenville, MI

Other NPIs with the same Medicare PAC ID 7

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

National Provider Directory

National Provider Directory
Tax ID family
Grand Rapids Opticians LLC11 organizations share this tax ID, including this one

Other organizations with this tax ID 10

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

Locations

10047 Crossroad Ct SE
Ste 310
Caledonia, MI 49316
Phone (616) 588-6556

Practitioners & affiliated clinicians

Practitioners 20

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

View all 20

NPI Registry JSON

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

{
    "created_epoch": "1173225600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1678320000000",
    "number": "1154452829",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "750 E BELTLINE AVE NE",
            "city": "GRAND RAPIDS",
            "state": "MI",
            "postal_code": "495256049",
            "telephone_number": "616-942-1350",
            "fax_number": "616-949-1670"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "705 S GREENVILLE WEST DR STE 201",
            "city": "GREENVILLE",
            "state": "MI",
            "postal_code": "488383531",
            "telephone_number": "616-754-5667",
            "fax_number": "616-754-3071"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GRO OPTICAL, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-03-07",
        "last_updated": "2023-03-09",
        "certification_date": "2023-03-09",
        "status": "A",
        "authorized_official_last_name": "CLARK",
        "authorized_official_first_name": "DAVID",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "636-227-2600",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "332H00000X",
            "taxonomy_group": "",
            "desc": "Eyewear Supplier",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS OF MI",
            "identifier": "540D105120",
            "state": "MI"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "G.R.O. Optical",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "G.R.O. Optical LLC",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "GRO Optical LLC",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Grand Rapids Opticians, LLC",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Grand Rapids Opticians, LLC",
            "code": "4",
            "type": "Former Legal Business Name"
        }
    ]
}

Other providers in Greenville, MI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 9, 2023; 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.