Organization
LAKESHORE OPTICIANS
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. MICHAEL VANDERBAAN OPTICIAN (OWNER)
(616) 451-0896
Entity
Organization
Contact information
Practice address
717 BAGLEY AVE SE, GRAND RAPIDS, MI 49506-3001
(616) 451-0896
Mailing address
717 BAGLEY AVE SE, GRAND RAPIDS, MI 49506-3001
(616) 451-0896
Taxonomy
Speciality
Code
Description
License number
State
332H00000X
Eyewear Supplier
Primary
—
—
Other
Enumeration date
03/05/2008
Last updated
03/05/2008
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