1144340589 NPI number — THOMAS M. GRISCHOW, O.D., INC.

Table of content: (NPI 1144340589)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1144340589 NPI number — THOMAS M. GRISCHOW, O.D., INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
THOMAS M. GRISCHOW, O.D., INC.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
HOWLAND EYE CENTER
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1144340589
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/20/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
199 NILES CORTLAND RD SE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
WARREN
Provider Business Mailing Address State Name:
OH
Provider Business Mailing Address Postal Code:
44484-2426
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
330-856-1782
Provider Business Mailing Address Fax Number:
330-856-2760

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
199 NILES CORTLAND RD SE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WARREN
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
44484-2426
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
330-856-1782
Provider Business Practice Location Address Fax Number:
330-856-2760
Provider Enumeration Date:
03/30/2007

Additional Information

Authorized Official

Authorized Official Last Name:
GRISCHOW
Authorized Official First Name:
THOMAS
Authorized Official Middle Name:
M
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
330-856-1782

Provider Taxonomy Codes

  • Taxonomy code: 152W00000X , with the licence number:  4457 T1113 , registered in the state of OH ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: OP0517 . This is a "EYEMED" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".
  • Identifier: 52322 . This is a "DAVIS VISION" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".
  • Identifier: 29416 . This is a "SPECTERA" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".
  • Identifier: 279544883006 . This is a "MEDICAL MUTUAL" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".
  • Identifier: 7483230 . This is a "AETNA" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".
  • Identifier: 2559539 , issued by the state of ( OH ) . This identifiers is of the category "MEDICAID".
  • Identifier: 000000364655 . This is a "ANTHEM" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".




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