| Organization Name: | SHORELINE OPTICAL, INC. |
| NPI Number: | 1184781676 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | CHRISTOPHER GREK (EXECUTIVE DIRECTOR) |
| Mailing Address: | 1445 Sheldon Rd Suite 100 Grand Haven |
| State: | MI US |
| Postal Code: | 494172480 |
| Phone Number: | 6168421680 |
| Fax Number: | 6168428269 |
| NPI Enumeration Date: | 01/03/2007 |
| NPI Last Update Date: | 01/02/2013 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 156FX1800X |
| License Number: | |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | |
| Taxonomy Type: | Eye and Vision Services Providers |
| Taxonomy Classification: | Technician/Technologist |
| Taxonomy Specialization: | Optician |
| Taxonomy Definition: | |