NPIMap

Organization Active NPI

Gro Optical, LLC

Doing business as Grand Rapids Opticians, LLC

  • Eyewear Supplier
  • Holland, MI
National Provider Identifier
1487785135
Registry record updated Feb 15, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Eyewear SupplierTaxonomy code 332H00000X
Legal business name
GRO OPTICAL, LLC
Doing business as
GRO Optical LLC
GRO Optical, LLC
Practice address
3235 N Wellness Dr
Lakeshore Medical Campus
Holland, MI 49424-7264
Phone
(616) 994-9586
Fax
(616) 994-0105
NPI assigned
Mar 7, 2007
Last updated
Feb 15, 2021By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Feb 15, 2021

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

Authorized official

Name
Mr. Kelly McCrann
Title
Ceo
Phone
(636) 227-2600

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Eyewear Supplier 332H00000X NU Primary

Addresses

Primary practice location

3235 N Wellness Dr
Lakeshore Medical Campus
Holland, MI 49424-7264

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 3

  • GRO 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
O20100930031170 MI DME Supplier - Physician - Optometrist 5193842128 Practice locations: Holland, 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.

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": "1613347200000",
    "number": "1487785135",
    "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": "3235 N WELLNESS DR",
            "address_2": "LAKESHORE MEDICAL CAMPUS",
            "city": "HOLLAND",
            "state": "MI",
            "postal_code": "494247264",
            "telephone_number": "616-994-9586",
            "fax_number": "616-994-0105"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GRO OPTICAL, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-03-07",
        "last_updated": "2021-02-15",
        "certification_date": "2021-02-15",
        "status": "A",
        "authorized_official_last_name": "MCCRANN",
        "authorized_official_first_name": "KELLY",
        "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": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS OF MI",
            "identifier": "540D105120",
            "state": "MI"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "GRO 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 Holland, MI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 15, 2021; 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.