Healthcare Provider Details

I. General information

NPI: 1861046948
Provider Name (Legal Business Name): JASON J GRYGIER OD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/28/2019
Last Update Date: 07/28/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2600 POST RD STE 210
SOUTHPORT CT
06890-3206
US

IV. Provider business mailing address

33 N WATER ST UNIT 707
NORWALK CT
06854-2557
US

V. Phone/Fax

Practice location:
  • Phone: 203-255-4005
  • Fax:
Mailing address:
  • Phone: 740-602-0130
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number3108
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: