Healthcare Provider Details

I. General information

NPI: 1063969962
Provider Name (Legal Business Name): GRIN EYE CARE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/08/2016
Last Update Date: 09/08/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

21020 W 151ST ST
OLATHE KS
66061-7200
US

IV. Provider business mailing address

21020 W 151ST ST
OLATHE KS
66061-7200
US

V. Phone/Fax

Practice location:
  • Phone: 913-829-5511
  • Fax: 913-829-5571
Mailing address:
  • Phone: 913-829-5511
  • Fax: 913-829-5571

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number2026
License Number StateKS

VIII. Authorized Official

Name: DR. MILTON GRIN
Title or Position: OPHTHALMOLOGIST/OWNER
Credential: M.D., P.A.
Phone: 913-829-5511