Healthcare Provider Details

I. General information

NPI: 1699106740
Provider Name (Legal Business Name): GRILLO & COMPANY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/27/2013
Last Update Date: 10/13/2025
Certification Date: 10/13/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16701 MELFORD BLVD SUITE 400-#3487
BOWIE MD
20715-4411
US

IV. Provider business mailing address

16701 MELFORD BLVD SUITE 400-#3487
BOWIE MD
20715-4411
US

V. Phone/Fax

Practice location:
  • Phone: 443-204-3939
  • Fax: 888-609-9664
Mailing address:
  • Phone: 443-204-3939
  • Fax: 888-609-9664

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License NumberTA1396
License Number StateMD

VIII. Authorized Official

Name: DR. TERESA MARIA GRILLO
Title or Position: MANAGING MEMBER
Credential: O.D.
Phone: 443-204-3939